1487839932 NPI number — UCSF FRESNO MEDICAL GROUP

Table of content: (NPI 1487839932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487839932 NPI number — UCSF FRESNO MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF FRESNO MEDICAL GROUP
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:
UCSF FRESNO ALLIED MEDICAL GROUP
Provider Other Organization Name Type Code:
5
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:
1487839932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000
Provider Second Line Business Mailing Address:
FILE 740522
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-227-4810
Provider Business Mailing Address Fax Number:
559-227-4167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3313 N HILLIARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93726-5854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-227-4810
Provider Business Practice Location Address Fax Number:
559-227-4167
Provider Enumeration Date:
01/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VORIS
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOICATE DEAN
Authorized Official Telephone Number:
559-499-6427

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY19509 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103G00000X , with the licence number: 20822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CK5696 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ5296Y . This is a "BLUE OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9151935 . This is a "MEDI-CAL PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2342434 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GPS001380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0091021 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821014374 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".