Organization
RENEW LIFE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIETA MARIMLA GABIOLA MD (PRESIDENT)
(650) 350-1700
Entity
Organization
Contact information
Practice address
211 DE ANZA BLVD, SAN MATEO, CA 94402-3989
(650) 350-1700
(650) 341-3604
Mailing address
211 DE ANZA BLVD, SAN MATEO, CA 94402-3989
(650) 350-1700
(650) 341-3604
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AG51233
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G51233
MEDICAL LICENCE
CA
Enumeration date
06/24/2009
Last updated
03/07/2023
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