Healthcare Provider Details

I. General information

NPI: 1750818860
Provider Name (Legal Business Name): HEALTH LINK MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 NORTHGATE DR STE 400
SAN RAFAEL CA
94903-3667
US

IV. Provider business mailing address

899 NORTHGATE DR STE 400
SAN RAFAEL CA
94903-3667
US

V. Phone/Fax

Practice location:
  • Phone: 415-223-7504
  • Fax: 415-223-7505
Mailing address:
  • Phone: 415-223-7504
  • Fax: 415-223-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB FLORES
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 760-721-4000