Provider Demographics
NPI:1043359615
Name:SAN FRANCISCO COMMUNITY COLLEGE DISTRICT
Entity Type:Organization
Organization Name:SAN FRANCISCO COMMUNITY COLLEGE DISTRICT
Other - Org Name:STUDENT HEALTH SERVICE, SF CITY COLLEGE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE CHANCELLOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-239-3192
Mailing Address - Street 1:50 PHELAN AVE
Mailing Address - Street 2:HC 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1821
Mailing Address - Country:US
Mailing Address - Phone:415-239-3110
Mailing Address - Fax:415-239-3193
Practice Address - Street 1:50 PHELAN AVE
Practice Address - Street 2:HC 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1821
Practice Address - Country:US
Practice Address - Phone:415-239-3110
Practice Address - Fax:415-239-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191280261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health