Healthcare Provider Details

I. General information

NPI: 1528254117
Provider Name (Legal Business Name): PENINSULA SURGICAL SPECIALIST MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 EL CAMINO REAL SUITE 101
BURLINGAME CA
94010-3224
US

IV. Provider business mailing address

1720 EL CAMINO REAL SUITE 101
BURLINGAME CA
94010-3224
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-0600
  • Fax: 650-652-0605
Mailing address:
  • Phone: 650-652-0600
  • Fax: 650-652-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA ALMES
Title or Position: MANAGER
Credential:
Phone: 650-777-4064