1154585859 NPI number — MS. CLARE KATHLEEN MCNAMARA MPAS, PA-C

Table of content: MS. CLARE KATHLEEN MCNAMARA MPAS, PA-C (NPI 1154585859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154585859 NPI number — MS. CLARE KATHLEEN MCNAMARA MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNAMARA
Provider First Name:
CLARE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154585859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
354 VALLEY VIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95127-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-215-8485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 OAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94305-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-725-5308
Provider Business Practice Location Address Fax Number:
650-725-9218
Provider Enumeration Date:
07/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA19131 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com