Provider Demographics
NPI:1174633663
Name:QUATTRO MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:QUATTRO MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-044-0000
Mailing Address - Street 1:723 CAMINO PLAZA
Mailing Address - Street 2:BOX 225
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3401
Mailing Address - Country:US
Mailing Address - Phone:415-644-0000
Mailing Address - Fax:650-952-0568
Practice Address - Street 1:1838 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3126
Practice Address - Country:US
Practice Address - Phone:415-644-0000
Practice Address - Fax:650-952-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG482432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97827Medicare UPIN