Healthcare Provider Details

I. General information

NPI: 1265407381
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 23RD ST 2ND FLOOR, ROOM 2110
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

PO BOX 743749
LOS ANGELES CA
90074-3749
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-9031
  • Fax:
Mailing address:
  • Phone: 415-514-3000
  • Fax: 415-502-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE FERNANDEZ
Title or Position: DIRECTOR UCSF SFGH CPG BUSINESS
Credential:
Phone: 415-206-8969