Provider Demographics
NPI:1598848632
Name:SAN MATEO SURGERY CENTER
Entity type:Organization
Organization Name:SAN MATEO SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-570-0529
Mailing Address - Street 1:66 BOVET RD # 101-103
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3125
Mailing Address - Country:US
Mailing Address - Phone:650-570-0529
Mailing Address - Fax:650-570-0500
Practice Address - Street 1:66 BOVET RD
Practice Address - Street 2:SUITE 101-103
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3125
Practice Address - Country:US
Practice Address - Phone:650-570-0529
Practice Address - Fax:650-570-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14028ZMedicare UPIN