Basic Information
| Provider Information | |||||||||
| NPI: | 1891989976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN MATEO COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 W 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503728555 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 W 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503728555 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 08/31/2007 | ||||||||
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| AuthorizedOfficialLastName: | LUCANA | ||||||||
| AuthorizedOfficialFirstName: | SONIA | ||||||||
| AuthorizedOfficialMiddleName: | CELMIRA | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 66503728555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW/ASW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | ASW 15873 | CA | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.