Provider Demographics
NPI:1750941977
Name:COUNTY OF SAN MATEO
Entity type:Organization
Organization Name:COUNTY OF SAN MATEO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES MANAGER II - NURS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-363-7875
Mailing Address - Street 1:300 BRADFORD ST.
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-363-7875
Mailing Address - Fax:650-599-1082
Practice Address - Street 1:300 BRADFORD ST.
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-363-7875
Practice Address - Fax:650-599-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN MATEO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health