Provider Demographics
NPI:1043463441
Name:SAN MATEO SPINE CENTER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAN MATEO SPINE CENTER A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-685-9940
Mailing Address - Street 1:101 S SAN MATEO DRIVE SUITE 301
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-558-1802
Mailing Address - Fax:
Practice Address - Street 1:101 S SAN MATEO DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3844
Practice Address - Country:US
Practice Address - Phone:650-558-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty