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Organization
CALIFORNIA PACIFIC VASCULAR LABORATORY MEDICAL ASSOCIATE
Active
Organization
CALIFORNIA PACIFIC VASCULAR LABORATORY MEDICAL ASSOCIATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN B LONG MD (PHYSICIAN)
(415) 221-7056
Entity
Organization
Contact information
Practice address
3838 CALIFORNIA ST, SUITE 612, SAN FRANCISCO, CA 94118-1522
(415) 221-7056
(415) 221-7058
Mailing address
3838 CALIFORNIA ST, SUITE 612, SAN FRANCISCO, CA 94118-1522
(415) 221-7056
(415) 221-7058
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ42476Z
BCBS
CA
Enumeration date
03/29/2007
Last updated
02/06/2015
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