Healthcare Provider Details

I. General information

NPI: 1194259887
Provider Name (Legal Business Name): STANLEY CONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 MESA VERDE WAY
SAN CARLOS CA
94070-4283
US

IV. Provider business mailing address

164 MESA VERDE WAY
SAN CARLOS CA
94070-4283
US

V. Phone/Fax

Practice location:
  • Phone: 415-407-2421
  • Fax:
Mailing address:
  • Phone: 415-407-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number9129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: