1598730616 NPI number — UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598730616 NPI number — UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CALIFORNIA SFGH 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 SFGH MEDICAL GROUP DEPT OF NEUROSURGERY
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:
1598730616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2013
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:
415-514-3000
Provider Business Mailing Address Fax Number:
415-502-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVE
Provider Second Line Business Practice Location Address:
RM 4M39
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-3219
Provider Business Practice Location Address Fax Number:
415-502-4985
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR UCSF SFGH CPG BUSINESS
Authorized Official Telephone Number:
415-206-8969

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZP3858Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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