MEDICARE: CALIFORNIA PACIFIC SPECIALTY SERVICES

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	204F00000X	Transplant Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ07860Z	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1508909466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA PACIFIC SPECIALTY SERVICES

Provider Business Mailing Address
First Line	:	2302 FILLMORE ST
Second Line	:	SUITE A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1813
Country	:	US
Telephone Number	:	415-931-3313
Fax Number	:	415-931-3003

Provider Business Practice Location Address
First Line	:	2302 FILLMORE ST
Second Line	:	SUITE A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1813
Country	:	US
Telephone Number	:	415-931-3313
Fax Number	:	415-931-3003

Authorized Official
Title or Position	:	DIRECTOR OFFICER
Name	:	MS. MICHELE GANDOLFO
Credential	:
Telephone Number	:	415-931-3313

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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Directions to “CALIFORNIA PACIFIC SPECIALTY SERVICES ” Practice Location

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