Provider Demographics
NPI:1386948172
Name:SAN FRANCISCO VA MEDICAL CENTER
Entity type:Organization
Organization Name:SAN FRANCISCO VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HBPC MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-750-2045
Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:ROUTING # 181HBPC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-379-5512
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:ROUTING # 181HBPC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-379-5512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA776821261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA