Provider Demographics
NPI:1992874960
Name:UCSF CENTER FOR CRANIOFACIAL ANOMALIES
Entity type:Organization
Organization Name:UCSF CENTER FOR CRANIOFACIAL ANOMALIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:BERTOLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-1323
Mailing Address - Street 1:513 PARNASSUS AVENUE S-747
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0442
Mailing Address - Country:US
Mailing Address - Phone:415-476-2271
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVENUE S-747
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0442
Practice Address - Country:US
Practice Address - Phone:415-476-2271
Practice Address - Fax:415-476-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223P0106X, 1223P0221X, 1223P0700X, 1223S0112X, 1223X0400X, 204E00000X, 207N00000X, 207NP0225X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040390OtherMEDI-CAL PROVIDER #
CA1072OtherDELTA DENTAL PROVIDER #
CAG01072-01OtherDENTI-CAL PROVIDER #