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General NPI Number Information
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NPI Number | 1326585449
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Entity Type | Organization
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Legal Business Name | GOLDEN GATE UROLOGY INC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 2999 REGENT ST SUITE 612 & 626
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City | BERKELEY
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State | CA
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Zip | 94705-2190
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Country | US
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Telephone | 510-495-3332
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Fax | 510-848-8224
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Provider Business Mailing Address
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Address Line | 2999 REGENT ST SUITE 612
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City | BERKELEY
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State | CA
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Zip | 94705-2190
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Country | US
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Telephone | 510-495-3332
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Fax | 510-848-8224
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Authorized Official
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Title or Position | VP, FINANCE AND ADMINISTRATION
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Name | SARA BETANCOURT
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Credential |
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Telephone | 415-543-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | A71078
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License Number State | CA
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