Healthcare Provider Details

I. General information

NPI: 1104919208
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVENUE
SAN FRANCISCO CA
94143-0296
US

IV. Provider business mailing address

505 PARNASSUS AVENUE P.O. BOX 0296
SAN FRANCISCO CA
94143-0296
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2742
  • Fax: 415-353-2765
Mailing address:
  • Phone: 415-353-2742
  • Fax: 415-353-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARK ROBERT LARET
Title or Position: CEO
Credential:
Phone: 415-353-2733