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General NPI Number Information
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NPI Number | 1013472950
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Entity Type | Organization
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Legal Business Name | PRADEEPA SELVAKUMAR MD INC, A CALIFORNIA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 101 S SAN MATEO DR STE 102
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City | SAN MATEO
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State | CA
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Zip | 94401-3840
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Country | US
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Telephone | 650-435-8211
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Fax | 844-965-9436
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Provider Business Mailing Address
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Address Line | 2889 BAZE RD
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City | SAN MATEO
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State | CA
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Zip | 94403-3436
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Country | US
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Telephone | 415-778-0813
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRADEEPA SELVAKUMAR
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Credential | MD
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Telephone | 650-435-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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