Healthcare Provider Details

I. General information

NPI: 1598657454
Provider Name (Legal Business Name): MARC CHRISTIAN CALLEJO MOLINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

127 36TH AVE
SAN MATEO CA
94403-4402
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-369-6465
Mailing address:
  • Phone: 650-766-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number276750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: