Healthcare Provider Details

I. General information

NPI: 1104136464
Provider Name (Legal Business Name): UCSF MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE SUITE S672 D
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

513 PARNASSUS AVE SUITE S672 D
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-8482
  • Fax:
Mailing address:
  • Phone: 415-502-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberA112369
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREA GERARD GONZALEZ
Title or Position: CLINICAL FELLOW
Credential: M.D
Phone: 415-242-1180