1992874960 NPI number — UCSF CENTER FOR CRANIOFACIAL ANOMALIES

Table of content: (NPI 1992874960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992874960 NPI number — UCSF CENTER FOR CRANIOFACIAL ANOMALIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF CENTER FOR CRANIOFACIAL ANOMALIES
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:
1992874960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 PARNASSUS AVENUE S-747
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:
94143-0442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-476-2271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 PARNASSUS AVENUE S-747
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:
94143-0442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-476-2271
Provider Business Practice Location Address Fax Number:
415-476-9513
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERTOLAMI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
415-476-1323

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0221X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0700X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223S0112X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223X0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 204E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207N00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207NP0225X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2086S0122X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: GR0040390 . This is a "MEDI-CAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1072 . This is a "DELTA DENTAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G01072-01 . This is a "DENTI-CAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".