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General NPI Number Information
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NPI Number | 1720130412
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Entity Type | Organization
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Legal Business Name | ST. ELIZABETH ANN SETON NEW LIFE CENTER
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 1500 SOUTHGATE AVE SUITE 112
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City | DALY CITY
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State | CA
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Zip | 94015-2259
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Country | US
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Telephone | 650-301-8875
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Fax | 650-301-8880
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Provider Business Mailing Address
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Address Line | 1500 SOUTHGATE AVE SUITE 112
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City | DALY CITY
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State | CA
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Zip | 94015-2259
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Country | US
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Telephone | 650-301-8875
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Fax | 650-301-8880
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MRS. MARGARITA MENDOZA
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Credential |
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Telephone | 650-301-8875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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