1235191305 NPI number — UCSF DERMATOPATHOLOGY SERVICE

Table of content: (NPI 1235191305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235191305 NPI number — UCSF DERMATOPATHOLOGY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF DERMATOPATHOLOGY SERVICE
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:
6
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:
1235191305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 DIVISADERO ST, STE 280
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:
94115-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-497-0244
Provider Business Mailing Address Fax Number:
415-353-7543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 DIVISADERO ST
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-497-0244
Provider Business Practice Location Address Fax Number:
415-353-7553
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALMONT
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
415-353-7550

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR0074010 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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