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General NPI Number Information
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NPI Number | 1336030881
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Entity Type | Individual
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Provider Name | RICHARD MBIAD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 285 SANTA TERESA ST
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City | STANFORD
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State | CA
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Zip | 94305-8001
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Country | US
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Telephone | 650-498-0765
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Fax |
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Provider Business Mailing Address
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Address Line | 334 PACIFIC AVE
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City | PACIFICA
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State | CA
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Zip | 94044-2622
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Country | US
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Telephone | 415-797-8149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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