Organization
WELLBOUND OF MENLO PARK LLC
Active
Parent organization
WELLBOUND LLC
Other names
Satellite Wellbound of Fremont
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLBOUND LLC
Authorized official
BERNADETTE VINCENT (PRESIDENT/COO)
(650) 404-3600
Entity
Organization
Contact information
Practice address
39510 PASEO PADRE PKWY, SUITE 100, FREMONT, CA 94538-4707
(510) 953-7800
(510) 739-3810
Mailing address
300 SANTANA ROW, SUITE 300, SAN JOSE, CA 95128-2423
(510) 953-7800
(650) 625-6007
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1015752
CMS CLIA CERTIFICATE OF WAIVER
CA
05
—
CDC52514F
—
CA
Enumeration date
02/03/2006
Last updated
04/12/2023
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