Provider Demographics
NPI:1699061267
Name:SMARTLOSS MEDICINE, INC.
Entity type:Organization
Organization Name:SMARTLOSS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-701-1460
Mailing Address - Street 1:595 PRICE AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1464
Mailing Address - Country:US
Mailing Address - Phone:650-701-1460
Mailing Address - Fax:
Practice Address - Street 1:595 PRICE AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1464
Practice Address - Country:US
Practice Address - Phone:650-701-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65939207P00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty