Provider Demographics
NPI:1760788038
Name:UHS AT CALIFORNIA BERKELY TANG CENTER
Entity Type:Organization
Organization Name:UHS AT CALIFORNIA BERKELY TANG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAREER RN ALLERGY/TRAVEL
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORGI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-643-7177
Mailing Address - Street 1:2222 BANCROFT WAY SPC 4300
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4300
Mailing Address - Country:US
Mailing Address - Phone:510-643-7177
Mailing Address - Fax:510-643-9790
Practice Address - Street 1:2222 BANCROFT AVE.
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-643-7177
Practice Address - Fax:510-643-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267742261QC1500X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA267742Other26LEVEL ONE HEALTH CARE PROVIDER
CA163W00000XOtherLEVEL 1 PROVIDER RN