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General NPI Number Information
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NPI Number | 1942524772
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER FOR DIABETES & METABOLIC CARE INC.
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 1850 SULLIVAN AVE STE 510
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City | DALY CITY
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State | CA
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Zip | 94015-2230
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Country | US
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Telephone | 215-630-1361
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Fax | 866-258-6628
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Provider Business Mailing Address
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Address Line | 1361 BRENTWOOD RD
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City | YARDLEY
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State | PA
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Zip | 19067-3924
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Country | US
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Telephone | 650-808-7430
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Fax | 866-258-6628
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Authorized Official
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Title or Position | PRESIDENT
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Name | MYRNA L SORIANO
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Credential | MD
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Telephone | 215-630-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A 38854
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License Number State | CA
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