Healthcare Provider Details

I. General information

NPI: 1073836060
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE RM. 5H22
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8317
  • Fax: 415-476-5582
Mailing address:
  • Phone: 415-502-7648
  • Fax: 415-476-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE FERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 415-206-8969