Healthcare Provider Details

I. General information

NPI: 1083942254
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE RM U585 BOX 0748
SAN FRANCISCO CA
94143-2208
US

IV. Provider business mailing address

533 PARNASSUS AVE RM U585 BOX 0748
SAN FRANCISCO CA
94143-2208
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberA107505
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberA107505
License Number StateCA

VIII. Authorized Official

Name: ANTHONY PORTALE
Title or Position: DIVISION CHIEF
Credential: MD
Phone: 415-476-2423