Provider Demographics
NPI:1356479984
Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Other - Org Name:UCSF IMMUNOGENETICS AND TRANSPLANTATION LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS AND ADMINIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-3883
Mailing Address - Street 1:45 CASTRO ST
Mailing Address - Street 2:MAIN HOSPITAL, LEVEL B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-476-3883
Mailing Address - Fax:415-476-0379
Practice Address - Street 1:45 CASTRO ST
Practice Address - Street 2:MAIN HOSPITAL, LEVEL B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-476-3883
Practice Address - Fax:415-476-0379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 3207291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05HL06Medicare Oscar/Certification