Healthcare Provider Details

I. General information

NPI: 1649641796
Provider Name (Legal Business Name): SPHERICAL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 EARNEST ST
HERCULES CA
94547-2726
US

IV. Provider business mailing address

1154 EARNEST ST
HERCULES CA
94547-2726
US

V. Phone/Fax

Practice location:
  • Phone: 415-420-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA73148
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY EDWARD ALLEN
Title or Position: DOCTOR
Credential: MD
Phone: 415-420-4325