1518068550 NPI number — VETERANS AFFAIRS PALO ALTO

Table of content: (NPI 1518068550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518068550 NPI number — VETERANS AFFAIRS PALO ALTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETERANS AFFAIRS PALO ALTO
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:
1518068550
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:
34495 SHENANDOAH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94555-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-493-5000
Provider Business Mailing Address Fax Number:
650-849-0505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE
Provider Second Line Business Practice Location Address:
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:
Provider Enumeration Date:
09/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RENFRO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
NURSE MANAGER/CLINICAL COORDINATOR
Authorized Official Telephone Number:
650-493-5000

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  504790 , 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)