Healthcare Provider Details

I. General information

NPI: 1265829501
Provider Name (Legal Business Name): SAN MATEO COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 90TH ST
DALY CITY CA
94015-1807
US

IV. Provider business mailing address

380 90TH ST
DALY CITY CA
94015-1807
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number210005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number21005
License Number StateCA

VIII. Authorized Official

Name: DIANE ROBERTS
Title or Position: MEDICAL STAFF OFFICE
Credential:
Phone: 650-301-8600