Provider Demographics
NPI:1720130412
Name:ST. ELIZABETH ANN SETON NEW LIFE CENTER
Entity type:Organization
Organization Name:ST. ELIZABETH ANN SETON NEW LIFE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-301-8875
Mailing Address - Street 1:1500 SOUTHGATE AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2259
Mailing Address - Country:US
Mailing Address - Phone:650-301-8875
Mailing Address - Fax:650-301-8880
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2259
Practice Address - Country:US
Practice Address - Phone:650-301-8875
Practice Address - Fax:650-301-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094560OtherMEDI-CAL