Healthcare Provider Details

I. General information

NPI: 1487714945
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG 30 5TH FLOOR
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: 415-206-6842
  • Fax: 415-206-8949
Mailing address:
  • Phone: 415-502-7648
  • Fax: 415-502-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

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