Healthcare Provider Details

I. General information

NPI: 1306295787
Provider Name (Legal Business Name): NABEEL MADANAT M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 EL CAMINO REAL STE 701
BURLINGAME CA
94010-3122
US

IV. Provider business mailing address

1828 EL CAMINO REAL STE 701
BURLINGAME CA
94010-3122
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-9022
  • Fax: 650-652-9029
Mailing address:
  • Phone: 650-652-9022
  • Fax: 650-652-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA50176
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA50176
License Number StateCA

VIII. Authorized Official

Name: NABEEL JAMEEL MADANAT
Title or Position: OWNER
Credential: M.D.
Phone: 650-652-9022