Healthcare Provider Details

I. General information

NPI: 1356405583
Provider Name (Legal Business Name): MATOSO-TOGNETTI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 GATEWAY DR SUITE 110
SAN MATEO CA
94404-2470
US

IV. Provider business mailing address

1810 GATEWAY DR SUITE 110
SAN MATEO CA
94404-2470
US

V. Phone/Fax

Practice location:
  • Phone: 650-345-2739
  • Fax: 650-345-2756
Mailing address:
  • Phone: 650-345-2739
  • Fax: 650-345-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT29585
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT28347
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT1423X
License Number StateCA

VIII. Authorized Official

Name: MS. KIMBERLY NICOLE HIGHTOWER
Title or Position: OFFICE MANAGER
Credential:
Phone: 650-345-2739