Provider Demographics
NPI:1528228442
Name:UCSF-FRESNO
Entity Type:Organization
Organization Name:UCSF-FRESNO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-459-6000
Mailing Address - Street 1:2823 FRESNO ST
Mailing Address - Street 2:SURGERY, FIRST FLOOR
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1324
Mailing Address - Country:US
Mailing Address - Phone:559-459-6000
Mailing Address - Fax:
Practice Address - Street 1:2823 FRESNO ST
Practice Address - Street 2:SURGERY, FIRST FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1324
Practice Address - Country:US
Practice Address - Phone:559-459-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10299282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital