Healthcare Provider Details

I. General information

NPI: 1457779951
Provider Name (Legal Business Name): AMADALIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 PINRAIL LN
FOSTER CITY CA
94404-4608
US

IV. Provider business mailing address

632 PINRAIL LN
FOSTER CITY CA
94404-4608
US

V. Phone/Fax

Practice location:
  • Phone: 805-907-9093
  • Fax:
Mailing address:
  • Phone: 805-907-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS HERNANDEZ
Title or Position: VICE PRESIDENT FINANCES
Credential:
Phone: 650-784-0460