1508426222 NPI number — MADELEINE MILLER-BOTTOME PH.D.

Table of content: MADELEINE MILLER-BOTTOME PH.D. (NPI 1508426222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508426222 NPI number — MADELEINE MILLER-BOTTOME PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER-BOTTOME
Provider First Name:
MADELEINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1508426222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 DISTEL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94022-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-600-5959
Provider Business Mailing Address Fax Number:
415-369-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 DUBOCE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUITE 250
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94114-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-600-5959
Provider Business Practice Location Address Fax Number:
415-369-1392
Provider Enumeration Date:
06/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  32847 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 32847 , 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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