Healthcare Provider Details

I. General information

NPI: 1932256294
Provider Name (Legal Business Name): MARINER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 E HILLSDALE BLVD STE 1
FOSTER CITY CA
94404-1236
US

IV. Provider business mailing address

1241 E HILLSDALE BLVD 2ND FLOOR
FOSTER CITY CA
94404-1241
US

V. Phone/Fax

Practice location:
  • Phone: 650-570-2299
  • Fax: 650-570-5949
Mailing address:
  • Phone: 650-570-2299
  • Fax: 650-570-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA83248
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA80784
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG79688
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG48428
License Number StateCA

VIII. Authorized Official

Name: KAREN SAUERMANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 650-570-2299