Provider Demographics
NPI:1629436134
Name:DMAT CA-6
Entity Type:Organization
Organization Name:DMAT CA-6
Other - Org Name:CDMSA
Other - Org Type:Other Name
Authorized Official - Title/Position:UNIT COMMANDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:292-731-3755
Mailing Address - Street 1:101 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2940
Mailing Address - Country:US
Mailing Address - Phone:202-731-3755
Mailing Address - Fax:650-412-1815
Practice Address - Street 1:520 LOOP RD
Practice Address - Street 2:BLDG 4, A-137
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:202-731-3755
Practice Address - Fax:650-412-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64161251K00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable