Healthcare Provider Details

I. General information

NPI: 1740486315
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 6B
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: 415-206-5270
  • Fax: 415-206-4722
Mailing address:
  • Phone: 415-502-7648
  • Fax: 415-476-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. BLANCA F VALLE
Title or Position: COMPLIANCE ANALYST
Credential:
Phone: 415-206-5290