1295774172 NPI number — CC-PALO ALTO, INC.

Table of content: (NPI 1295774172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295774172 NPI number — CC-PALO ALTO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CC-PALO ALTO, INC.
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:
VI AT PALO ALTO
Provider Other Organization Name Type Code:
3
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:
1295774172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 S WACKER DR
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-803-8520
Provider Business Mailing Address Fax Number:
312-896-5177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SAND HILL RD
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:
94304-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-853-5085
Provider Business Practice Location Address Fax Number:
650-853-5112
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COPE
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP & GENERAL COUNSEL
Authorized Official Telephone Number:
312-803-8555

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  550000146 , 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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