Organization
GOLDEN GATE UROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA BETANCOURT (DIRECTOR OF FINANCE)
(415) 543-2830
Entity
Organization
Contact information
Practice address
1661 MISSION ST, SAN FRANCISCO, CA 94103-2413
(415) 543-2830
(415) 543-2830
Mailing address
DEPT LA 23565, PASADENA, CA 91185-3565
(415) 543-2830
(415) 354-3431
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063640738
—
CA
01
—
DP8077
RAILROAD MEDICARE
CA
Enumeration date
07/01/2009
Last updated
07/24/2023
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