Provider Demographics
NPI:1487839932
Name:UCSF FRESNO MEDICAL GROUP
Entity Type:Organization
Organization Name:UCSF FRESNO MEDICAL GROUP
Other - Org Name:UCSF FRESNO ALLIED MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOICATE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:559-499-6427
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE 740522
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:559-227-4810
Mailing Address - Fax:559-227-4167
Practice Address - Street 1:3313 N HILLIARD ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5854
Practice Address - Country:US
Practice Address - Phone:559-227-4810
Practice Address - Fax:559-227-4167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19509103G00000X
CA20822103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK5696OtherRAILROAD MEDICARE
CAZZZ5296YOtherBLUE OF CA
CA9151935OtherMEDI-CAL PIN
CA2342434Medicaid
CAGPS001380Medicaid
CAGR0091021Medicaid
CA1821014374OtherNPI
CA2342434Medicaid