1760788038 NPI number — UHS AT CALIFORNIA BERKELY TANG CENTER

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 1760788038 NPI number — UHS AT CALIFORNIA BERKELY TANG CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UHS AT CALIFORNIA BERKELY TANG CENTER
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:
1760788038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 BANCROFT WAY SPC 4300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94720-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-643-7177
Provider Business Mailing Address Fax Number:
510-643-9790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 BANCROFT AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94720-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-643-7177
Provider Business Practice Location Address Fax Number:
510-643-9790
Provider Enumeration Date:
02/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SORGI
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CAREER RN ALLERGY/TRAVEL
Authorized Official Telephone Number:
510-643-7177

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  267742 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: 267742 , 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)

  • Identifier: 267742 . This is a "26LEVEL ONE HEALTH CARE PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 163W00000X . This is a "LEVEL 1 PROVIDER RN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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