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General NPI Number Information
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NPI Number | 1881181493
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Entity Type | Organization
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Legal Business Name | THE METABOLIC HEALTH CLINIC, INC.
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 845 OAK GROVE AVE STE 110
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City | MENLO PARK
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State | CA
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Zip | 94025-4445
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Country | US
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Telephone | 650-538-6515
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Fax | 888-706-5628
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Provider Business Mailing Address
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Address Line | 3645 HAVEN AVE APT 4104
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City | MENLO PARK
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State | CA
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Zip | 94025-1084
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Country | US
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Telephone | 650-450-3079
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANUEL LAM
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Credential | MD
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Telephone | 650-538-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A113533
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License Number State | CA
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