Provider Demographics
NPI:1003964685
Name:IMEDD INC. A MEDICAL GROUP
Entity Type:Organization
Organization Name:IMEDD INC. A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARIFFO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-697-0600
Mailing Address - Street 1:1663 ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2301
Mailing Address - Country:US
Mailing Address - Phone:650-697-0600
Mailing Address - Fax:650-652-7805
Practice Address - Street 1:1663 ROLLINS RD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2301
Practice Address - Country:US
Practice Address - Phone:650-697-0600
Practice Address - Fax:650-652-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN