Healthcare Provider Details

I. General information

NPI: 1144777921
Provider Name (Legal Business Name): FOSTER FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SHELL BLVD
FOSTER CITY CA
94404-2983
US

IV. Provider business mailing address

PO BOX 8231 1050 SHELL BLVD.
FOSTER CITY CA
94404-8231
US

V. Phone/Fax

Practice location:
  • Phone: 650-349-8384
  • Fax:
Mailing address:
  • Phone: 650-349-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: PRINCESS LEIA LUCAS
Title or Position: CHAIRMAN OF THE BOARD/S
Credential:
Phone: 650-349-8384