# CALIFORNIA PACIFIC VASCULAR LABORATORY MEDICAL ASSOCIATE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780704353
- **Authorized official:** JOHN B LONG MD (PHYSICIAN)
- **Authorized official phone:** (415) 221-7056

## Contact information

- **Practice address:** 3838 CALIFORNIA ST, SUITE 612, SAN FRANCISCO, CA 94118-1522
- **Practice address phone:** (415) 221-7056
- **Practice address fax:** (415) 221-7058
- **Mailing address:** 3838 CALIFORNIA ST, SUITE 612, SAN FRANCISCO, CA 94118-1522
- **Mailing address phone:** (415) 221-7056
- **Mailing address fax:** (415) 221-7058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 02/06/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ42476Z | BCBS | CA |