Provider Demographics
NPI:1437673092
Name:UCSF GENOMIC MEDICINE LABORATORY
Entity Type:Organization
Organization Name:UCSF GENOMIC MEDICINE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ZIFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FACMG
Authorized Official - Phone:415-502-0747
Mailing Address - Street 1:513 PARNASSUS AVE, S965
Mailing Address - Street 2:BOX 0794
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0794
Mailing Address - Country:US
Mailing Address - Phone:415-502-3560
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVENUE, HSW901A
Practice Address - Street 2:HSW901A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0793
Practice Address - Country:US
Practice Address - Phone:415-502-3560
Practice Address - Fax:415-476-2956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2080584291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory