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General NPI Number Information
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NPI Number | 1629436134
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Entity Type | Organization
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Legal Business Name | DMAT CA-6
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 08/27/2016
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Provider Practice Location Address
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Address Line | 520 LOOP RD BLDG 4, A-137
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City | PALO ALTO
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State | CA
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Zip | 94304-1207
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Country | US
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Telephone | 202-731-3755
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Fax | 650-412-1815
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Provider Business Mailing Address
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Address Line | 101 DALE AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-2940
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Country | US
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Telephone | 202-731-3755
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Fax | 650-412-1815
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Authorized Official
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Title or Position | UNIT COMMANDER
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Name | DAVID LIPIN
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Credential |
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Telephone | 292-731-3755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | G64161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | G64161
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License Number State | CA
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