MEDICARE: MILLBRAE SERRA SANITARIUM 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	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386632438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLBRAE SERRA SANITARIUM INC.

Provider Business Mailing Address
First Line	:	150 SERRA AVE
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2629
Country	:	US
Telephone Number	:	650-697-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SERRA AVE
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2629
Country	:	US
Telephone Number	:	650-697-7000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VINCE MUZZI
Credential	:
Telephone Number	:	650-697-7000

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/22/2020

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Directions to “MILLBRAE SERRA SANITARIUM INC. ” Practice Location

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