Healthcare Provider Details

I. General information

NPI: 1174032353
Provider Name (Legal Business Name): GOLDEN GATE UROLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 TOWNSEND ST STE 100
SAN FRANCISCO CA
94107-1946
US

IV. Provider business mailing address

139 TOWNSEND ST STE 100
SAN FRANCISCO CA
94107-1946
US

V. Phone/Fax

Practice location:
  • Phone: 415-541-0800
  • Fax: 415-543-2811
Mailing address:
  • Phone: 415-541-0800
  • Fax: 415-543-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SARA BETANCOURT
Title or Position: VP, FINANCE AND ADMINISTRATION
Credential:
Phone: 415-543-2812