Healthcare Provider Details

I. General information

NPI: 1497945810
Provider Name (Legal Business Name): SAN FRANCISCO COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PHELAN AVE HC100
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

50 PHELAN AVE HC100
SAN FRANCISCO CA
94112-1821
US

V. Phone/Fax

Practice location:
  • Phone: 415-239-3110
  • Fax: 415-239-3193
Mailing address:
  • Phone: 415-239-3110
  • Fax: 415-239-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number261QS1000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. PETER GOLDSTEIN
Title or Position: VICE CHANCELLOR OF FINANCE AND ADMI
Credential:
Phone: 415-241-2229