=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568697357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RDD ICF, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2009
-----------------------------------------------------
Last Update Date | 05/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 741 ADA ST
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-216-9455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2893 EL CAMINO REAL STE C
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94061-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-216-9960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DEYRA TAMBOT SUNGA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 650-892-4572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | 220000350
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------