Healthcare Provider Details

I. General information

NPI: 1740374008
Provider Name (Legal Business Name): SETON MEDICAL CENTER COATSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARINE BLVD
MOSS BEACH CA
94038-9641
US

IV. Provider business mailing address

1900 SULLIVAN AVE
DALY CITY CA
94015-2229
US

V. Phone/Fax

Practice location:
  • Phone: 650-991-6488
  • Fax: 650-991-6683
Mailing address:
  • Phone: 650-991-6488
  • Fax: 650-991-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHSP45702
License Number StateCA

VIII. Authorized Official

Name: MRS. MARTHA E YASAVOLIAN
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 650-991-6488