| South Drive Medical Clinic | |
|
515 S Drive #15 Mountain View CA 94040-4209 | |
| (650) 961-9430 | |
| Not Available |
| Full Name | South Drive Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 515 S Drive, Mountain View, California |
| Authorized Official Name and Position | Kenneth S Peters (PRESIDENT) |
| Authorized Official Contact | 6509619430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Drive Medical Clinic 515 S Drive #15 Mountain View CA 94040-4209 Ph: (650) 961-9430 | South Drive Medical Clinic 515 S Drive #15 Mountain View CA 94040-4209 Ph: (650) 961-9430 |
| NPI Number | 1043248560 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043248560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY4724 (California) | Primary |
| 207R00000X | Internal Medicine | G33788 (California) | Primary |
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