Healthcare Provider Details

I. General information

NPI: 1669748026
Provider Name (Legal Business Name): ENDOCRINOLOGY, METABOLISM AND CLINICAL NUTRITION PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S SAN MATEO DR SUITE 370
SAN MATEO CA
94401-3857
US

IV. Provider business mailing address

1325 HOWARD AVEUNE NO 825
BULINGAME CA
94010
US

V. Phone/Fax

Practice location:
  • Phone: 650-347-0063
  • Fax:
Mailing address:
  • Phone: 650-347-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberA78806
License Number StateCA

VIII. Authorized Official

Name: SUMBUL BEG
Title or Position: OWNER
Credential: MD
Phone: 650-347-0063