Provider Demographics
NPI:1528164100
Name:BURLINGAME-PACIFICA MEDICAL GROUP , INC.
Entity type:Organization
Organization Name:BURLINGAME-PACIFICA MEDICAL GROUP , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ERHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-697-4195
Mailing Address - Street 1:1860 EL CAMINO REAL STE 439
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3117
Mailing Address - Country:US
Mailing Address - Phone:650-697-4195
Mailing Address - Fax:650-697-4233
Practice Address - Street 1:1860 EL CAMINO REAL STE 439
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3117
Practice Address - Country:US
Practice Address - Phone:650-697-4195
Practice Address - Fax:650-697-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111219173F00000X, 207Q00000X, 207Q00000X
CAA100772207R00000X
CAG191030207RC0000X
CAG132750207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002122Medicaid
CAGR0002122Medicaid