Organization
BRIGHTLINE MEDICAL AFFILIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GRODBERG MD (CHIEF OF PSYCHIATRY)
(917) 587-0024
Entity
Organization
Contact information
Practice address
400 CONCAR DR, SAN MATEO, CA 94402-2681
(650) 456-5777
Mailing address
400 CONCAR DR, SAN MATEO, CA 94402-2681
(650) 456-5777
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/29/2021
Last updated
01/03/2023
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