1710457510 NPI number — UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP

Table of content: (NPI 1710457510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710457510 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:
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:
1710457510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-3749
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:
BLDG 3 RM 102
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:
628-206-8212
Provider Business Practice Location Address Fax Number:
628-206-5988
Provider Enumeration Date:
12/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
TERREL
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM DIRECTOR
Authorized Official Telephone Number:
415-476-3625

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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