Healthcare Provider Details

I. General information

NPI: 1528005055
Provider Name (Legal Business Name): PACIFIC GYNECOLOGY & OBSTETRICS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 319
SAN FRANCISCO CA
94115-2373
US

IV. Provider business mailing address

2100 WEBSTER ST STE 319
SAN FRANCISCO CA
94115-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3123
  • Fax: 415-923-3132
Mailing address:
  • Phone: 415-923-3123
  • Fax: 415-923-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG11319
License Number StateCA

VIII. Authorized Official

Name: MS. ETHEL CERDA
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-923-3087