Healthcare Provider Details

I. General information

NPI: 1508938846
Provider Name (Legal Business Name): UCSF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE # MU320-W
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

500 PARNASSUS AVE # MU320-W
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1167
  • Fax: 415-476-1304
Mailing address:
  • Phone: 415-476-1167
  • Fax: 415-476-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG85464
License Number StateCA

VIII. Authorized Official

Name: DR. LISA LEE LATTANZA
Title or Position: CHIEF, ELBOW RECONSTRUCTIVE SURGERY
Credential: M.D.
Phone: 415-476-1167