Healthcare Provider Details

I. General information

NPI: 1720547953
Provider Name (Legal Business Name): JODI GEDALLOVICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JODI LAPIDUS

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/27/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

UCSF DEPARTMENT OF SURGERY 513 PARNASSUS AVENUE, S321
SAN FRANCSICO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: