Basic Information
| Provider Information | |||||||||
| NPI: | 1790843985 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA PACIFIC MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7999 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156007180 | ||||||||
| FaxNumber: | 4156007185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 BUCHANAN STREET | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156007180 | ||||||||
| FaxNumber: | 4156007185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOLDSWORTH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF ADMINISTRATIONS CFO | ||||||||
| AuthorizedOfficialTelephone: | 4156003959 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 220000197 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | 282N00000X | 220000197 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | X00500473 | 05 | TX | MEDICAID |