Basic Information
| Provider Information | |||||||||
| NPI: | 1720261464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN MATEO MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 W 39T H AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 SOUTH CABRILLO HIGHWAY | ||||||||
| Address2: | #100A | ||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505733911 | ||||||||
| FaxNumber: | 6507264963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2007 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROZZI | ||||||||
| AuthorizedOfficialFirstName: | KRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6505732120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.