# MILLS PENINSULA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mills-Peninsula Medical Group Clinics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588879134
- **Authorized official:** TRUDY BRADY LVN (CLINIC DIRECTOR)
- **Authorized official phone:** (650) 240-8011

## Contact information

- **Practice address:** 50 S SAN MATEO DR, SUITE 150, SAN MATEO, CA 94401-3857
- **Practice address phone:** (650) 696-9770
- **Practice address fax:** (650) 375-1363
- **Mailing address:** 50 S SAN MATEO DR, SUITE 150, SAN MATEO, CA 94401-3857
- **Mailing address phone:** (650) 696-9770
- **Mailing address fax:** (650) 375-1363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 01/31/2008