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LIVEWELL MEDICAL CLINIC INC NPI 1770675886


NPI Information

NPI: 1770675886
Provider Name: LIVEWELL MEDICAL CLINIC INC
Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
1150 EL CAMINO REAL
#225
SAN BRUNO, CA
ZIP 94066
Phone: (650) 873-3338
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LIVEWELL MEDICAL CLINIC INC is a pediatrics in San Bruno, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LIVEWELL MEDICAL CLINIC INC NPI is 1770675886. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1150 EL CAMINO REAL
#225
SAN BRUNO, CA
ZIP 94066
Phone: (650) 873-3338
Fax: (650) 873-3308

The provider's authorized official is Maria Luisa Osmona .
The authorized official title is President Owner and has the following contact phone number (650) 873-3338.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsA78723CALIFORNIANo
2208000000XPediatricsG78328CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0101840MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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