Provider Demographics
NPI:1376136499
Name:HEALTHTAP MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:HEALTHTAP MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:650-268-9806
Mailing Address - Street 1:209 E JAVA DR
Mailing Address - Street 2:UNIT 61987
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94088-8020
Mailing Address - Country:US
Mailing Address - Phone:650-268-9806
Mailing Address - Fax:
Practice Address - Street 1:4370 ALPINE ROAD
Practice Address - Street 2:STE 206
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7953
Practice Address - Country:US
Practice Address - Phone:650-268-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty