Organization
PENINSULA NEPHROLOGY, INC.
Active
Other names
San Mateo Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA JANSEN RN, BS, MBA (CEO)
(650) 377-0200
Entity
Organization
Contact information
Practice address
2000 S EL CAMINO REAL, SAN MATEO, CA 94403-1805
(650) 377-0200
(650) 358-3906
Mailing address
2000 S EL CAMINO REAL, SAN MATEO, CA 94403-1805
(650) 377-0200
(650) 358-3906
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02819F
—
CA
Enumeration date
08/10/2005
Last updated
08/22/2020
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