Organization
WAVECREST MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRIS C KEALEY MD (CEO)
(650) 985-0530
Entity
Organization
Contact information
Practice address
1850 SULLIVAN AVE, SUITE 320, DALY CITY, CA 94015-2221
(650) 985-0530
(650) 985-0535
Mailing address
1850 SULLIVAN AVE, SUITE 320, DALY CITY, CA 94015-2221
(650) 985-0530
(650) 985-0535
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0101480
—
CA
Enumeration date
08/30/2006
Last updated
10/03/2011
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