=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386619419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 POTRERO AVE. BLDG. 80, 6TH FL, WARD 86
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 628-476-4082
-----------------------------------------------------
Fax | 625-476-6953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 743749
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90074-3749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-514-3000
-----------------------------------------------------
Fax | 415-502-8175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM DIRECTOR
-----------------------------------------------------
Name | TERREL ROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-476-3625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------