Healthcare Provider Details

I. General information

NPI: 1295605178
Provider Name (Legal Business Name): COUNTY OF SAN MATEO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

801 GATEWAY BLVD STE 200
SOUTH SAN FRANCISCO CA
94080-7402
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2222
  • Fax:
Mailing address:
  • Phone: 650-421-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PAPA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 650-573-2613