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General NPI Number Information
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NPI Number | 1043463441
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Entity Type | Organization
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Legal Business Name | SAN MATEO SPINE CENTER A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 101 S SAN MATEO DR STE 301
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City | SAN MATEO
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State | CA
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Zip | 94401-3844
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Country | US
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Telephone | 650-558-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S SAN MATEO DRIVE SUITE 301
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City | SAN MATEO
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State | CA
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Zip | 94401
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Country | US
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Telephone | 650-558-1802
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DENISE KUBICK
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Credential |
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Telephone | 650-685-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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