Provider Demographics
NPI:1821233958
Name:SAN MATEO MEDICAL CENTER
Entity Type:Organization
Organization Name:SAN MATEO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPFS
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-573-2120
Mailing Address - Street 1:222 W 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4364
Mailing Address - Country:US
Mailing Address - Phone:650-573-2222
Mailing Address - Fax:
Practice Address - Street 1:630 LAUREL ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2977
Practice Address - Country:US
Practice Address - Phone:650-701-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SA MATEO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000015261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028871Medicaid