Provider Demographics
NPI:1205931078
Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CERYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-353-1849
Mailing Address - Street 1:1701 DIVISADERO ST STE 500
Mailing Address - Street 2:UCSF MT. ZION GENERAL MEDICINE CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3011
Mailing Address - Country:US
Mailing Address - Phone:415-353-7930
Mailing Address - Fax:415-353-7932
Practice Address - Street 1:1701 DIVISADERO ST STE 500
Practice Address - Street 2:UCSF MT. ZION GENERAL MEDICINE CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3011
Practice Address - Country:US
Practice Address - Phone:415-353-7930
Practice Address - Fax:415-353-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL151760Medicaid
CAOPL151760Medicaid