Healthcare Provider Details

I. General information

NPI: 1750138152
Provider Name (Legal Business Name): PENINSULA HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S EL CAMINO REAL STE 300
SAN MATEO CA
94403-2381
US

IV. Provider business mailing address

2600 S EL CAMINO REAL STE 300
SAN MATEO CA
94403-2381
US

V. Phone/Fax

Practice location:
  • Phone: 650-226-7030
  • Fax:
Mailing address:
  • Phone: 650-226-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARC A RAPPAPORT
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 650-226-7030