Healthcare Provider Details

I. General information

NPI: 1730450552
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 23RD ST BLDG 92ND
SAN FRANCISCO CA
94110-3504
US

IV. Provider business mailing address

2550 23RD ST BLDG 92ND
SAN FRANCISCO CA
94110-3504
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8812
  • Fax: 415-647-3733
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA96934
License Number StateCA

VIII. Authorized Official

Name: SUSAN CARLISLE
Title or Position: ASSOCIATE DEAN
Credential: MD
Phone: 415-206-8505