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General NPI Number Information
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NPI Number | 1538241252
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Entity Type | Organization
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Legal Business Name | SAN BRUNO PEDIATRICS INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 1001 SNEATH LANE SUITE 104
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City | SAN BRUNO
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State | CA
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Zip | 94066
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Country | US
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Telephone | 650-873-4545
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Fax | 650-873-4544
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Provider Business Mailing Address
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Address Line | 5528 PACHECO BLVD STE A
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City | PACHECO
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State | CA
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Zip | 94553
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Country | US
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Telephone | 925-363-8170
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Fax | 925-363-4995
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA VANESSA ABUNTO
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Credential | MD
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Telephone | 650-873-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A80451
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A60694
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License Number State | CA
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