Provider Demographics
NPI:1063692762
Name:SAN MATEO COUNTY
Entity type:Organization
Organization Name:SAN MATEO COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIJMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-573-2517
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:STE 235
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1269
Mailing Address - Country:US
Mailing Address - Phone:650-573-2517
Mailing Address - Fax:650-573-8939
Practice Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:STE 235
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1269
Practice Address - Country:US
Practice Address - Phone:650-573-2517
Practice Address - Fax:650-573-8939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN MATEO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-09
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063692762Medicaid