Basic Information
| Provider Information | |||||||||
| NPI: | 1366853871 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY HEALTHCARE ALLIANCE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OBGYN PARTNERS FOR HEALTH MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 COLBY ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108931700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 COLBY ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108931700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | RUSLEN | ||||||||
| AuthorizedOfficialFirstName: | KRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5109748297 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.