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General NPI Number Information
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NPI Number | 1104201334
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Entity Type | Organization
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Legal Business Name | SAN MATEO RHEUMATOLOGY INC.
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 101 S SAN MATEO DR SUITE 307
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City | SAN MATEO
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State | CA
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Zip | 94401-3819
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Country | US
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Telephone | 650-348-6011
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Fax | 650-348-6027
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Provider Business Mailing Address
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Address Line | 101 S SAN MATEO DR SUITE 307
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City | SAN MATEO
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State | CA
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Zip | 94401-3819
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Country | US
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Telephone | 650-348-6011
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Fax | 650-348-6027
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P STEVENS
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Credential | MD
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Telephone | 650-348-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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