MEDICARE: DR. MARK E VONZASTROW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	G68180	CA

General Provider Information

NPI Number	:	1063686202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E VONZASTROW MD

Provider Business Mailing Address
First Line	:	600 16TH ST
Second Line	:	N212E GENENTECH HALL / UCSF
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94158-2517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 16TH ST
Second Line	:	N212E GENENTECH HALL / UCSF
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94158-2517
Country	:	US
Telephone Number	:	415-476-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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