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General NPI Number Information
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NPI Number | 1174633663
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Entity Type | Organization
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Legal Business Name | QUATTRO MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1838 EL CAMINO REAL SUITE 101
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City | BURLINGAME
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State | CA
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Zip | 94010-3126
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Country | US
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Telephone | 415-644-0000
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Fax | 650-952-0568
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Provider Business Mailing Address
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Address Line | 723 CAMINO PLAZA BOX 225
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City | SAN BRUNO
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State | CA
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Zip | 94066-3401
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Country | US
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Telephone | 415-644-0000
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Fax | 650-952-0568
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Authorized Official
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Title or Position | CEO
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Name | MARK ANDREW HEITNER
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Credential | MD
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Telephone | 415-044-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G48243
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License Number State | CA
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