Healthcare Provider Details

I. General information

NPI: 1952449076
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE BOX 0706
SAN FRANCISCO CA
94143-2208
US

IV. Provider business mailing address

1991 CAMINO A LOS CERROS
MENLO PARK CA
94025-5959
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberAA 88919
License Number StateCA

VIII. Authorized Official

Name: DR. YLAYALY KATHERINE BIANCO
Title or Position: CLINICAL INSTRUTOR
Credential: MD
Phone: 415-514-9399