Provider Demographics
NPI:1386615458
Name:SATELLITE HEALTHCARE OF SAN CARLOS, LLC
Entity type:Organization
Organization Name:SATELLITE HEALTHCARE OF SAN CARLOS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:300 SANTANA ROW
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:650-366-0789
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:1125 INDUSTRIAL ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4159
Practice Address - Country:US
Practice Address - Phone:650-366-0789
Practice Address - Fax:650-366-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000628261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02793FMedicaid
CA140000628OtherSTATE OF CALIFORNIA
CA140000628OtherSTATE OF CALIFORNIA