Provider Demographics
NPI: | 1760552343 |
---|---|
Name: | REGENTS OF THE UNIVERSITY OF CALIFORNIA |
Entity Type: | Organization |
Organization Name: | REGENTS OF THE UNIVERSITY OF CALIFORNIA |
Other - Org Name: | UCSF DEPT OF MEDICINE GENERAL MEDICINE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | INTERIM VICE DEAN, ADMINISTRATION |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-476-4003 |
Mailing Address - Street 1: | 1635 DIVISADERO ST |
Mailing Address - Street 2: | SUITE 625, BOX 1821 |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94143-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-476-4029 |
Mailing Address - Fax: | 415-476-4150 |
Practice Address - Street 1: | 505 PARNASSUS AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94143-0120 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-353-4624 |
Practice Address - Fax: | 415-353-2640 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UCSF MEDICAL CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-11-09 |
Last Update Date: | 2011-01-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 220000091 | 207R00000X, 207RA0201X, 207RC0000X, 207RE0101X, 207RG0100X, 207RG0300X, 207RH0003X, 207RI0200X, 207RN0300X, 207RP1001X, 207RR0500X, 207RX0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RA0201X | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR0084563 | Medicaid | |
CA | ZZZP3886Z | Medicare ID - Type Unspecified |