Healthcare Provider Details

I. General information

NPI: 1124300652
Provider Name (Legal Business Name): ZARA RACHEL MATHEWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE SMMC EMERGENCY DEPARTMENT
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

320 PALO ALTO AVE APT B1
PALO ALTO CA
94301-1147
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2671
  • Fax:
Mailing address:
  • Phone: 330-472-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number135767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: