Provider Demographics
NPI:1063640738
Name:GOLDEN GATE UROLOGY INC
Entity Type:Organization
Organization Name:GOLDEN GATE UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-543-2830
Mailing Address - Street 1:DEPT LA 23565
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3565
Mailing Address - Country:US
Mailing Address - Phone:415-543-2830
Mailing Address - Fax:415-354-3431
Practice Address - Street 1:1661 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2413
Practice Address - Country:US
Practice Address - Phone:415-543-2830
Practice Address - Fax:415-543-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADP8077OtherRAILROAD MEDICARE
CA1063640738Medicaid