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General NPI Number Information
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NPI Number | 1144662289
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Entity Type | Organization
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Legal Business Name | PENINSULA FAMILY YMCA
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1877 S GRANT ST
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City | SAN MATEO
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State | CA
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Zip | 94402-2647
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Country | US
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Telephone | 650-294-2614
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Fax |
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Provider Business Mailing Address
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Address Line | 1877 S GRANT ST
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City | SAN MATEO
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State | CA
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Zip | 94402-2647
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Country | US
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Telephone | 650-294-2614
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH AND WELLNESS
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Name | LAUREN GREEN
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Credential | M.S.
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Telephone | 650-294-2614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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