Provider Demographics
NPI:1881181493
Name:THE METABOLIC HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:THE METABOLIC HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-538-6515
Mailing Address - Street 1:3645 HAVEN AVE APT 4104
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1084
Mailing Address - Country:US
Mailing Address - Phone:650-450-3079
Mailing Address - Fax:
Practice Address - Street 1:845 OAK GROVE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4445
Practice Address - Country:US
Practice Address - Phone:650-538-6515
Practice Address - Fax:888-706-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113533261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty