Healthcare Provider Details

I. General information

NPI: 1992054340
Provider Name (Legal Business Name): UCSF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 6TH AVE
SAN FRANCISCO CA
94118-3815
US

IV. Provider business mailing address

742 6TH AVE
SAN FRANCISCO CA
94118-3815
US

V. Phone/Fax

Practice location:
  • Phone: 415-488-3629
  • Fax:
Mailing address:
  • Phone: 415-488-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number34846
License Number StateZZ

VIII. Authorized Official

Name: KATE SHIMSHOCK
Title or Position: FELLOWSHIP COORDINATOR
Credential:
Phone: 415-476-2981