Basic Information
| Provider Information | |||||||||
| NPI: | 1992870042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER WEST BAY MEDICAL FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7999 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941207999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156004280 | ||||||||
| FaxNumber: | 4156004255 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 SACRAMENTO ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941181625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156004280 | ||||||||
| FaxNumber: | 4156004255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | FLAUM | ||||||||
| AuthorizedOfficialFirstName: | MORRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4156004220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUTTER HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 05D0962082 | CA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.