Provider Demographics
NPI:1538101126
Name:CITY & COUNTY OF SAN FRANCISCO
Entity Type:Organization
Organization Name:CITY & COUNTY OF SAN FRANCISCO
Other - Org Name:BALBOA TEEN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ISTVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-759-4064
Mailing Address - Street 1:1001 POTRERO AVENUE
Mailing Address - Street 2:BUILDING 10 WARD 14 ROOM 1405
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-206-8338
Mailing Address - Fax:206-206-3837
Practice Address - Street 1:1000 CAYUGA AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-469-4512
Practice Address - Fax:415-469-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70466FMedicaid