Healthcare Provider Details

I. General information

NPI: 1255731980
Provider Name (Legal Business Name): FOSTER CITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 E HILLSDALE BLVD SUITE 270
FOSTER CITY CA
94404-1241
US

IV. Provider business mailing address

1241 E HILLSDALE BLVD SUITE 270
FOSTER CITY CA
94404-1241
US

V. Phone/Fax

Practice location:
  • Phone: 650-918-5080
  • Fax:
Mailing address:
  • Phone: 650-918-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA125461
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA125461
License Number StateCA

VIII. Authorized Official

Name: RAJAN DAVE
Title or Position: CEO
Credential: M.D.
Phone: 650-918-5080