Provider Demographics
NPI:1801967625
Name:WHEELCHAIRS OF SAN MATEO
Entity type:Organization
Organization Name:WHEELCHAIRS OF SAN MATEO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-342-4864
Mailing Address - Street 1:808 BURLWAY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1710
Mailing Address - Country:US
Mailing Address - Phone:650-342-4864
Mailing Address - Fax:650-342-4868
Practice Address - Street 1:808 BURLWAY RD STE 7
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1710
Practice Address - Country:US
Practice Address - Phone:650-342-4864
Practice Address - Fax:650-342-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100778332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01712FMedicaid
CA0338790001Medicare ID - Type Unspecified