1326585449 NPI number — GOLDEN GATE UROLOGY INC

Table of content: (NPI 1326585449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326585449 NPI number — GOLDEN GATE UROLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN GATE UROLOGY INC
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:
Provider Other Organization Name Type Code:
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:
1326585449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2999 REGENT ST
Provider Second Line Business Mailing Address:
SUITE 612
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94705-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-495-3332
Provider Business Mailing Address Fax Number:
510-848-8224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 REGENT ST
Provider Second Line Business Practice Location Address:
SUITE 612 & 626
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-495-3332
Provider Business Practice Location Address Fax Number:
510-848-8224
Provider Enumeration Date:
01/26/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BETANCOURT
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, FINANCE AND ADMINISTRATION
Authorized Official Telephone Number:
415-543-2812

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  A71078 , 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)