MEDICARE: DEL MONTE ICF INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55G095	OTHER	CA	LONG TERM CARE

General Provider Information

NPI Number	:	1265657209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL MONTE ICF INC

Provider Business Mailing Address
First Line	:	210 DEL MONTE AVE
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-2220
Country	:	US
Telephone Number	:	650-876-0549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2893 EL CAMINO REAL
Second Line	:	SUITE C
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4001
Country	:	US
Telephone Number	:	650-216-9960
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ROSEMARIE TAMBOT VERIDIANO
Credential	:	PHARMACIST
Telephone Number	:	650-580-2983

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “DEL MONTE ICF INC ” Practice Location

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