Provider Demographics
NPI:1497945810
Name:SAN FRANCISCO COMMUNITY COLLEGE DISTRICT
Entity Type:Organization
Organization Name:SAN FRANCISCO COMMUNITY COLLEGE DISTRICT
Other - Org Name:CITY COLLEGE OF SAN FRANCISCO
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE CHANCELLOR OF FINANCE AND ADMI
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-241-2229
Mailing Address - Street 1:50 PHELAN AVE
Mailing Address - Street 2:HC100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1821
Mailing Address - Country:US
Mailing Address - Phone:415-239-3110
Mailing Address - Fax:415-239-3193
Practice Address - Street 1:50 PHELAN AVE
Practice Address - Street 2:HC100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1821
Practice Address - Country:US
Practice Address - Phone:415-239-3110
Practice Address - Fax:415-239-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1000X261QS1000X
CA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70730FOtherMEDI-CAL PROVIDER NUMBER