| Wavecrest Medicine, Inc. | |
|
1850 Sullivan Ave Suite 320 Daly City CA 94015-2221 | |
| (650) 985-0530 | |
| (650) 985-0535 |
| Full Name | Wavecrest Medicine, Inc. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1850 Sullivan Ave, Daly City, California |
| Authorized Official Name and Position | Kris C Kealey (CEO) |
| Authorized Official Contact | 6509850530 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wavecrest Medicine, Inc. 1850 Sullivan Ave Suite 320 Daly City CA 94015-2221 Ph: (650) 985-0530 | Wavecrest Medicine, Inc. 1850 Sullivan Ave Suite 320 Daly City CA 94015-2221 Ph: (650) 985-0530 |
| NPI Number | 1619087988 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 10/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619087988 | NPI | - | NPPES |
| GR0101480 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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