1649542192 NPI number — SATELLITE HEALTHCARE OF NORTH SAN MATEO COUNTY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649542192 NPI number — SATELLITE HEALTHCARE OF NORTH SAN MATEO COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SATELLITE HEALTHCARE OF NORTH SAN MATEO COUNTY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SATELLITE HEALTHCARE DALY CITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649542192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SANTANA ROW
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-746-3140
Provider Business Mailing Address Fax Number:
650-625-6007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 JUNIPERO SERRA BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94014-3891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-746-3140
Provider Business Practice Location Address Fax Number:
650-991-2840
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
BERNADETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/COO
Authorized Official Telephone Number:
650-404-3600

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649542192 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550002288 . This is a "STATE OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com