Healthcare Provider Details

I. General information

NPI: 1811364607
Provider Name (Legal Business Name): ROBERT LEE HUTCHINSON II HS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2686 SPRING ST
REDWOOD CITY CA
94063-3522
US

IV. Provider business mailing address

2686 SPRING ST
REDWOOD CITY CA
94063-3522
US

V. Phone/Fax

Practice location:
  • Phone: 650-368-3345
  • Fax: 650-368-9017
Mailing address:
  • Phone: 650-368-3345
  • Fax: 650-368-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: