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General NPI Number Information
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NPI Number | 1053650762
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Entity Type | Organization
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Legal Business Name | RICHARD F. GRAVINA, M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 333 N. SAN MATEO DRIVE
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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 | 650-348-6811
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Fax | 650-348-3651
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Provider Business Mailing Address
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Address Line | 333 N. SAN MATEO DRIVE
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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 | 650-348-6811
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Fax | 650-348-3651
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD FRANK GRAVINA
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Credential | M.D.
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Telephone | 650-348-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 00G244450
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License Number State | CA
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