1215051735 NPI number — DR. EUGENE SANBORN URBAIN PH.D.

Table of content: DR. EUGENE SANBORN URBAIN PH.D. (NPI 1215051735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215051735 NPI number — DR. EUGENE SANBORN URBAIN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URBAIN
Provider First Name:
EUGENE
Provider Middle Name:
SANBORN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1215051735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2564 SAN CARLOS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN CARLOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94070-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-544-3935
Provider Business Mailing Address Fax Number:
650-594-1632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 FREMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LOS ALTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94024-5698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-544-3935
Provider Business Practice Location Address Fax Number:
650-594-1632
Provider Enumeration Date:
03/19/2007

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: 103TC0700X , with the licence number:  PSY 15652 , 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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