Provider Demographics
NPI:1356316475
Name:UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Other - Org Name:UCSF SFGH MEDICAL GROUP DEPT OF DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR UCSF SFGH CPG BUSINESS
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:415-206-8969
Mailing Address - Street 1:PO BOX 743749
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3749
Mailing Address - Country:US
Mailing Address - Phone:415-514-3000
Mailing Address - Fax:415-502-8175
Practice Address - Street 1:1001 POTRERO AVENUE
Practice Address - Street 2:BLDG 100 RM 342
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:628-206-8843
Practice Address - Fax:415-282-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP3857ZMedicaid
CAZZZP3857ZMedicaid