Basic Information
| Provider Information | |||||||||
| NPI: | 1770688848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALPETER | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 WINWARD WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944042499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502880600 | ||||||||
| FaxNumber: | 6506858043 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 BOVET RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505541000 | ||||||||
| FaxNumber: | 6505541018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A42816 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | A42816 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RG0300X | A42816 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A428160 | 05 | CA | MEDICAID |