Healthcare Provider Details

I. General information

NPI: 1285258517
Provider Name (Legal Business Name): PURPLE WHALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N EL CAMINO REAL UNIT 106
SAN MATEO CA
94401-3760
US

IV. Provider business mailing address

800 N EL CAMINO REAL UNIT 106
SAN MATEO CA
94401-3760
US

V. Phone/Fax

Practice location:
  • Phone: 415-919-8939
  • Fax:
Mailing address:
  • Phone: 415-919-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ARWA MOTIWALA
Title or Position: FOUNDER
Credential: PT
Phone: 415-919-8939