1467990465 NPI number — STANFORD HEALTH CARE

Table of content: (NPI 1467990465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467990465 NPI number — STANFORD HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANFORD HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STANFORD HEALTH CARE PLEASANTON 5565
Provider Other Organization Name Type Code:
3
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:
1467990465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 EMBARCADERO RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5565 W LAS POSITAS BLVD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94588-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-734-8130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CONNOR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
650-725-1074

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 070000662 , 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)





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