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General NPI Number Information
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NPI Number | 1023488970
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Entity Type | Organization
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Legal Business Name | MAIN STREET MEDICAL
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 799 MAIN ST SUITE D
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City | HALF MOON BAY
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State | CA
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Zip | 94019-1996
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Country | US
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Telephone | 650-726-1200
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Fax | 650-726-1236
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Provider Business Mailing Address
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Address Line | 799 MAIN ST SUITE D
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City | HALF MOON BAY
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State | CA
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Zip | 94019-1996
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Country | US
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Telephone | 650-726-1200
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Fax | 650-726-1236
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. PAMELA CELESTE CARRINGTON-TRIBBLE
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Credential | D.O.
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Telephone | 650-726-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A6216
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License Number State | CA
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