Provider Demographics
NPI:1740373844
Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LARET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-353-2733
Mailing Address - Street 1:3360 GEARY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3398
Mailing Address - Country:US
Mailing Address - Phone:415-353-3100
Mailing Address - Fax:415-353-3131
Practice Address - Street 1:3360 GEARY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3398
Practice Address - Country:US
Practice Address - Phone:415-353-3100
Practice Address - Fax:415-353-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000208251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR07033HMedicaid
ZZZ06519ZOtherBLUE SHIELD
7660090OtherAETNA
057033OtherBLUE CROSS
CA057033Medicare ID - Type Unspecified