1043654486 NPI number — SUTTER BAY MEDICAL FOUNDATION

Table of content: (NPI 1043654486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043654486 NPI number — SUTTER BAY MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER BAY MEDICAL FOUNDATION
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:
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:
1043654486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 W EL CAMINO REAL
Provider Second Line Business Mailing Address:
CREDENTIALING DEPT, 2ND FLOOR
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94040-6201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-934-3526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2581 SAMARITAN DR
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95124-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-876-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VILARDO
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
650-934-3526

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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