Provider Demographics
NPI:1417188194
Name:UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA
Other - Org Name:TRAUMA RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCCELLARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-206-5070
Mailing Address - Street 1:2727 MARIPOSA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1472
Mailing Address - Country:US
Mailing Address - Phone:415-437-3000
Mailing Address - Fax:415-437-3050
Practice Address - Street 1:2727 MARIPOSA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1472
Practice Address - Country:US
Practice Address - Phone:415-437-3000
Practice Address - Fax:415-437-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)