1033690177 NPI number — STANFORD BLOOD CENTER, LLC

Table of content: (NPI 1033690177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033690177 NPI number — STANFORD BLOOD CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANFORD BLOOD CENTER, LLC
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:
6
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:
1033690177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3373 HILLVIEW AVE
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:
94304-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-725-7994
Provider Business Mailing Address Fax Number:
650-725-4470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3373 HILLVIEW 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:
94304-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-723-6304
Provider Business Practice Location Address Fax Number:
650-725-4470
Provider Enumeration Date:
08/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BRANAMAN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
650-723-7886

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF00011627 , 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)

  • Identifier: CLF00011627 . This is a "CLINICAL LABORATORY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0968614 . This is a "CLIA CERTIFICATE" identifier . This identifiers is of the category "OTHER".




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