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General NPI Number Information
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NPI Number | 1487478749
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Entity Type | Organization
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Legal Business Name | PENINSULA AMBULATORY MEDICAL SERVICES PC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 100 S ELLSWORTH AVE STE 504
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City | SAN MATEO
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State | CA
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Zip | 94401-3929
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Country | US
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Telephone | 650-507-3348
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MARKET ST # 238189
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW VARGAS
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Credential | MD
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Telephone | 404-502-5594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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