Provider Demographics
NPI:1265638159
Name:UNIVERSITY OF CALIFRONIA, SAN FRANCISCO
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFRONIA, SAN FRANCISCO
Other - Org Name:DEPARTMENT OF PSYCHIATRY, CHILD AND ADOLESCENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CPG BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-8969
Mailing Address - Street 1:PO BOX 7464
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7464
Mailing Address - Country:US
Mailing Address - Phone:415-502-0661
Mailing Address - Fax:415-476-6202
Practice Address - Street 1:1001 POTRERO AVE, BUILDING 5, SUITE 6B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-4444
Practice Address - Fax:415-206-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health