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222 W 39th Ave San Mateo CA 94403-4364 | |
| (650) 573-2222 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 222 W 39th Ave, San Mateo, California |
| Authorized Official Name and Position | David Scott Mcgrew (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6505732096 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
222 W 39th Ave San Mateo CA 94403-4364 Ph: (650) 573-2222 | 222 W 39th Ave San Mateo CA 94403-4364 Ph: (650) 573-2222 |
| NPI Number | 1144309055 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 02/19/2020 |
| Certification Date | 02/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144309055 | NPI | - | NPPES |
| GR0028886 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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