Basic Information
| Provider Information | |||||||||
| NPI: | 1790905156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCSF MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1689 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941224517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154207572 | ||||||||
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| Practice Location | |||||||||
| Address1: | SAN QUENTIN STATE PRISON | ||||||||
| Address2: | |||||||||
| City: | SAN QUENTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154541460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | TEH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 4154207572 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | NP12252 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.