Provider Demographics
NPI:1164820320
Name:CHRIS THREATT MD INC
Entity Type:Organization
Organization Name:CHRIS THREATT MD INC
Other - Org Name:SEQUOIA UROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-207-1272
Mailing Address - Street 1:570 EL CAMINO REAL # 150-446
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1200
Mailing Address - Country:US
Mailing Address - Phone:650-465-6038
Mailing Address - Fax:650-362-9440
Practice Address - Street 1:801 BREWSTER AVE STE 240
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1558
Practice Address - Country:US
Practice Address - Phone:650-465-6038
Practice Address - Fax:650-362-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79072208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty