Healthcare Provider Details

I. General information

NPI: 1518937051
Provider Name (Legal Business Name): MILLS-PENINSULA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

PO BOX 742738
LOS ANGELES CA
90074-2738
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-5400
  • Fax: 650-652-3052
Mailing address:
  • Phone: 650-696-5400
  • Fax: 650-652-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCA

VIII. Authorized Official

Name: JOHN GATES
Title or Position: CFO SHBA
Credential:
Phone: 510-450-7357