Healthcare Provider Details

I. General information

NPI: 1891415550
Provider Name (Legal Business Name): SANGRARIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 10/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 ALTSCHUL AVE
MENLO PARK CA
94025-6705
US

IV. Provider business mailing address

26718 BIRCH HILL WAY
LOS ALTOS HILLS CA
94022-3302
US

V. Phone/Fax

Practice location:
  • Phone: 650-387-8908
  • Fax:
Mailing address:
  • Phone: 650-465-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BOB S HU
Title or Position: CARDIOLOGIST
Credential: M.D.
Phone: 650-465-9149