| Purisima Family Medicine, Inc. | |
|
575 Kelly St Half Moon Bay CA 94019-1719 | |
| (650) 288-0508 | |
| (650) 713-0535 |
| Full Name | Purisima Family Medicine, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 575 Kelly St, Half Moon Bay, California |
| Authorized Official Name and Position | Daniel Eugene Mcmillan (PRESIDENT) |
| Authorized Official Contact | 6502880508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Purisima Family Medicine, Inc. Po Box 277 Half Moon Bay CA 94019-0277 Ph: (650) 288-0508 | Purisima Family Medicine, Inc. 575 Kelly St Half Moon Bay CA 94019-1719 Ph: (650) 288-0508 |
| NPI Number | 1881821387 |
|---|---|
| Provider Enumeration Date | 06/11/2009 |
| Last Update Date | 06/11/2009 |
| Medicare PECOS PAC ID | 6800942533 |
|---|---|
| Medicare Enrollment ID | O20090922000738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881821387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel E Mcmillan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588692107 PECOS PAC ID: 3375508120 Enrollment ID: I20090403000488 |
| Provider Name | Jill Pavliscak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144258765 PECOS PAC ID: 8325003171 Enrollment ID: I20091110000367 |
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