1265638159 NPI number — UNIVERSITY OF CALIFRONIA, SAN FRANCISCO

Table of content: (NPI 1265638159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265638159 NPI number — UNIVERSITY OF CALIFRONIA, SAN FRANCISCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CALIFRONIA, SAN FRANCISCO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEPARTMENT OF PSYCHIATRY, CHILD AND ADOLESCENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265638159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7464
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94120-7464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-502-0661
Provider Business Mailing Address Fax Number:
415-476-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVE, BUILDING 5, SUITE 6B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-4444
Provider Business Practice Location Address Fax Number:
415-206-3142
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CPG BUSINESS SERVICES
Authorized Official Telephone Number:
415-476-8969

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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