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General NPI Number Information
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NPI Number | 1750138152
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Entity Type | Organization
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Legal Business Name | PENINSULA HEALTH CARE DISTRICT
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Dates
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Enumeration Date | 05/02/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 2600 S EL CAMINO REAL STE 300
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City | SAN MATEO
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State | CA
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Zip | 94403-2381
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Country | US
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Telephone | 650-226-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S EL CAMINO REAL STE 300
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City | SAN MATEO
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State | CA
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Zip | 94403-2381
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Country | US
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Telephone | 650-226-7030
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARC A RAPPAPORT
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Credential | LMFT
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Telephone | 650-226-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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