Healthcare Provider Details

I. General information

NPI: 1053490094
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE MCB 300
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7788
  • Fax: 415-885-7718
Mailing address:
  • Phone: 415-476-4029
  • Fax: 415-476-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number220000091
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number220000091
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number220000091
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number220000091
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number220000091
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number220000091
License Number StateCA

VIII. Authorized Official

Name: MR. JED SHIVERS
Title or Position: COO
Credential:
Phone: 415-476-4003