Provider Demographics
NPI:1073154654
Name:GOLDEN GATE UROLOGY INC
Entity Type:Organization
Organization Name:GOLDEN GATE UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE AND ADMINISTRATION
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:415-543-2812
Mailing Address - Street 1:2186 GEARY BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3456
Mailing Address - Country:US
Mailing Address - Phone:415-922-3255
Mailing Address - Fax:
Practice Address - Street 1:2186 GEARY BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3456
Practice Address - Country:US
Practice Address - Phone:415-202-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty