Organization
REGENTS OF UNIVERSITY OF CALIFORNIA
Active
Parent organization
UNIVERSITY OF CA SAN FRANSICO
Other names
UCSF Fresno Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF CA SAN FRANSICO
Authorized official
DR. MICHAEL PETERSON M..D. (ASSOCIATE DEAN)
(559) 227-4810
Entity
Organization
Contact information
Practice address
2335 E KASHIAN LN STE 301, FRESNO, CA 93701-2234
(559) 227-4810
Mailing address
2335 E KASHIAN LN STE 301, FRESNO, CA 93701-2234
(559) 227-4810
(559) 227-4167
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY19509
CA
103G00000X
Clinical Neuropsychologist
PSY20822
CA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
G401330
CA
2084N0400X
Neurology Physician
Primary
G75668
CA
2084P0800X
Psychiatry Physician
20A7888
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821014374
MEDICARE NPI
CA
05
—
2342434
—
CA
05
—
9151935
—
CA
01
—
CK5696
RAILROAD MEDICARE
CA
05
—
GPS001380
—
CA
05
—
GR0091021
—
CA
01
—
ZZZ52969Y
BLUE OF CALIFORNIA
CA
Enumeration date
07/15/2006
Last updated
01/11/2019
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