1437443363 NPI number — MAYVIEW COMMUNITY HEALTH CENTER, INC.

Table of content: BRIAN LEE HOOPER D.C. (NPI 1285019554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437443363 NPI number — MAYVIEW COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYVIEW COMMUNITY HEALTH CENTER, 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:
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:
1437443363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 GRANT 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:
94306-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 MIRAMONTE AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-965-3323
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HASAN
Authorized Official First Name:
SHAMIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
650-327-1223

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  220000415 , 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: ZZR11533G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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