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General NPI Number Information
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NPI Number | 1669748026
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY, METABOLISM AND CLINICAL NUTRITION PRACTICE
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 50 S SAN MATEO DR SUITE 370
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City | SAN MATEO
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State | CA
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Zip | 94401-3857
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Country | US
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Telephone | 650-347-0063
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 HOWARD AVEUNE NO 825
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City | BULINGAME
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State | CA
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Zip | 94010
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Country | US
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Telephone | 650-347-0063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUMBUL BEG
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Credential | MD
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Telephone | 650-347-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | A78806
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License Number State | CA
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