Provider Demographics
NPI:1548460306
Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PNP PEDITATRIC TRANSPLANT CNV
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDGE-GROUT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:415-476-5892
Mailing Address - Street 1:PEDIATRIC TX MU 4 EAST BOX 0146 UCSF
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-5892
Mailing Address - Fax:415-476-1343
Practice Address - Street 1:PEDIATRIC TRANSPLANT MU 4 EAST BOX 0136
Practice Address - Street 2:300 PARNASSUS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0136
Practice Address - Country:US
Practice Address - Phone:415-476-5892
Practice Address - Fax:415-476-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271565261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty