Healthcare Provider Details

I. General information

NPI: 1003917923
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 100, RM 104
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

UCSF BOX 1284
SAN FRANCISCO CA
94143-1284
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4775
  • Fax: 415-206-6016
Mailing address:
  • Phone: 415-502-4775
  • Fax: 415-206-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT M. GRANT
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-743-4810