Provider Demographics
NPI:1568903508
Name:MEDICAL CENTER FOR DIABETES & METABOLIC CARE INC.
Entity Type:Organization
Organization Name:MEDICAL CENTER FOR DIABETES & METABOLIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-808-7430
Mailing Address - Street 1:1361 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3924
Mailing Address - Country:US
Mailing Address - Phone:650-808-7430
Mailing Address - Fax:866-258-6628
Practice Address - Street 1:1361 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-3924
Practice Address - Country:US
Practice Address - Phone:650-808-7430
Practice Address - Fax:866-258-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty