1184750861 NPI number — DR. KATHRYN JOANNE HALLSTEN M.D.

Table of content: DR. KATHRYN JOANNE HALLSTEN M.D. (NPI 1184750861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184750861 NPI number — DR. KATHRYN JOANNE HALLSTEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLSTEN
Provider First Name:
KATHRYN
Provider Middle Name:
JOANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALLSTEN RITCHEY
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
JOANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184750861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1156 RAMONA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94301-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-325-9906
Provider Business Mailing Address Fax Number:
650-325-1295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 PORTOLA RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PORTOLA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94028-7825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-385-1970
Provider Business Practice Location Address Fax Number:
650-851-9701
Provider Enumeration Date:
02/26/2007

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: 207R00000X , with the licence number:  G60511 , 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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