1437673092 NPI number — UCSF GENOMIC MEDICINE LABORATORY

Table of content: (NPI 1437673092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437673092 NPI number — UCSF GENOMIC MEDICINE LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF GENOMIC MEDICINE LABORATORY
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437673092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 PARNASSUS AVE, S965
Provider Second Line Business Mailing Address:
BOX 0794
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-0794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-502-3560
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 PARNASSUS AVENUE, HSW901A
Provider Second Line Business Practice Location Address:
HSW901A
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-0793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-502-3560
Provider Business Practice Location Address Fax Number:
415-476-2956
Provider Enumeration Date:
07/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VAN ZIFFLE
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
415-502-0747

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  05D2080584 , 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)





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