Provider Demographics
NPI:1720324841
Name:PACIFIC HEIGHTS MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC HEIGHTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-674-5223
Mailing Address - Street 1:2340 CLAY ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-674-5223
Mailing Address - Fax:415-600-3409
Practice Address - Street 1:2340 CLAY ST FL 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-674-5223
Practice Address - Fax:415-600-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765649261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care