Healthcare Provider Details

I. General information

NPI: 1699806059
Provider Name (Legal Business Name): PETER ANTONY DELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LAS PULGAS STE 209
SAN MATEO CA
94403-1222
US

IV. Provider business mailing address

1950 ALAMEDA DE LAS PULGAS STE 209
SAN MATEO CA
94403-1222
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-3571
  • Fax:
Mailing address:
  • Phone: 650-573-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA100801
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA100801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: