1740374008 NPI number — SETON MEDICAL CENTER COATSIDE

Table of content: (NPI 1740374008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740374008 NPI number — SETON MEDICAL CENTER COATSIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SETON MEDICAL CENTER COATSIDE
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:
Provider Other Organization Name Type Code:
6
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:
1740374008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 SULLIVAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-991-6488
Provider Business Mailing Address Fax Number:
650-991-6683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MARINE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSS BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94038-9641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-991-6488
Provider Business Practice Location Address Fax Number:
650-991-6683
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YASAVOLIAN
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
650-991-6488

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  HSP45702 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0555877 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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