Provider Demographics
NPI:1063604734
Name:SMCCD
Entity type:Organization
Organization Name:SMCCD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-358-6767
Mailing Address - Street 1:1700 W HILLSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3757
Mailing Address - Country:US
Mailing Address - Phone:650-574-6396
Mailing Address - Fax:650-574-6259
Practice Address - Street 1:1700 W HILLSDALE BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3757
Practice Address - Country:US
Practice Address - Phone:650-574-6396
Practice Address - Fax:650-574-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14521261QH0100X
CANP14521261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service