Provider Demographics
NPI:1306144209
Name:PENINSULA GASTROINTESTINAL
Entity type:Organization
Organization Name:PENINSULA GASTROINTESTINAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ONUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-342-7432
Mailing Address - Street 1:100 S ELLSWORTH AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3939
Mailing Address - Country:US
Mailing Address - Phone:650-342-7432
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3939
Practice Address - Country:US
Practice Address - Phone:650-342-7432
Practice Address - Fax:650-342-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty