1497885487 NPI number — VETERANS AFFAIRS PALO ALTO HEALTH CARE SYSTEMS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497885487 NPI number — VETERANS AFFAIRS PALO ALTO HEALTH CARE SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETERANS AFFAIRS PALO ALTO HEALTH CARE SYSTEMS
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:
1497885487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 MIRANDA AVE
Provider Second Line Business Mailing Address:
B101, B4-145 MC 154B
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-493-5000
Provider Business Mailing Address Fax Number:
650-858-3986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE
Provider Second Line Business Practice Location Address:
B101, B4-145 MC 154B
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-493-5000
Provider Business Practice Location Address Fax Number:
650-858-3986
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUTCHER
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PROFESSOR OF PATHOLOGY
Authorized Official Telephone Number:
650-493-5000

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  207ZI0100X , 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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