Provider Demographics
NPI:1467703272
Name:SAN CARLOS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SAN CARLOS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNISKERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAC, OMD
Authorized Official - Phone:650-593-4000
Mailing Address - Street 1:1328 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5005
Mailing Address - Country:US
Mailing Address - Phone:650-593-4000
Mailing Address - Fax:650-595-5667
Practice Address - Street 1:1328 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5005
Practice Address - Country:US
Practice Address - Phone:650-593-4000
Practice Address - Fax:650-595-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4728171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty