Basic Information
| Provider Information | |||||||||
| NPI: | 1346271814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF SAN MATEO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 POWELL STREET | ||||||||
| Address2: | STE 920 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502663 | ||||||||
| FaxNumber: | 5108799061 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 W 39TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732671 | ||||||||
| FaxNumber: | 6505732696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPIRO | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D VPO | ||||||||
| AuthorizedOfficialTelephone: | 5103502777 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF SAN MATEO | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.