Provider Demographics
NPI:1043365042
Name:UCSF SFGH CLINICAL PRACTICE GROUP
Entity Type:Organization
Organization Name:UCSF SFGH CLINICAL PRACTICE GROUP
Other - Org Name:DEPARTMENT OF PSYCHIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-476-6442
Mailing Address - Street 1:1930 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6228
Mailing Address - Country:US
Mailing Address - Phone:415-476-3598
Mailing Address - Fax:415-476-3655
Practice Address - Street 1:1930 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6228
Practice Address - Country:US
Practice Address - Phone:415-476-3598
Practice Address - Fax:415-476-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health