Provider Demographics
NPI:1023197944
Name:COUNTY OF SAN MATEO
Entity Type:Organization
Organization Name:COUNTY OF SAN MATEO
Other - Org Name:SAN MATEO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-573-2120
Mailing Address - Street 1:222 W 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4364
Mailing Address - Country:US
Mailing Address - Phone:650-573-2222
Mailing Address - Fax:
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:BLDG 334
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-599-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN MATEO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70035FOtherFQHC