| Renew Life Center | |
|
211 De Anza Blvd San Mateo CA 94402-3989 | |
| (650) 350-1700 | |
| (650) 341-3604 |
| Full Name | Renew Life Center |
|---|---|
| Speciality | Clinic/center |
| Location | 211 De Anza Blvd, San Mateo, California |
| Authorized Official Name and Position | Julieta Marimla Gabiola (PRESIDENT) |
| Authorized Official Contact | 6503501700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Life Center 211 De Anza Blvd San Mateo CA 94402-3989 Ph: (650) 350-1700 | Renew Life Center 211 De Anza Blvd San Mateo CA 94402-3989 Ph: (650) 350-1700 |
| NPI Number | 1609004084 |
|---|---|
| Provider Enumeration Date | 06/24/2009 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609004084 | NPI | - | NPPES |
| G51233 | Other | CA | MEDICAL LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | AG51233 (California) | Primary |
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