Healthcare Provider Details

I. General information

NPI: 1609267582
Provider Name (Legal Business Name): MATTHEW GENE HURRICANE HALL LCGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 QUARRY RD 2ND FLOOR, M/C 5992
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

211 QUARRY RD
PALO ALTO CA
94304-1416
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-5588
  • Fax: 650-725-9526
Mailing address:
  • Phone: 650-721-5588
  • Fax: 650-725-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: