| Organization Name: | MILLS PENINSULA MEDICAL GROUP |
| NPI Number: | 1588879134 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRUDY BRADY (CLINIC DIRECTOR) |
| Mailing Address: | 50 S San Mateo Dr Suite 150 San Mateo |
| State: | CA US |
| Postal Code: | 944013857 |
| Phone Number: | 6506969770 |
| Fax Number: | 6503751363 |
| NPI Enumeration Date: | 05/14/2007 |
| NPI Last Update Date: | 01/31/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |