1568764553 NPI number — MARGARET ELAINE HERMOSO RN, NP

Table of content: MARGARET ELAINE HERMOSO RN, NP (NPI 1568764553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568764553 NPI number — MARGARET ELAINE HERMOSO RN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMOSO
Provider First Name:
MARGARET
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEDLICKA
Provider Other First Name:
MARGARET
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568764553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ARGUELLO STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-851-4900
Provider Business Mailing Address Fax Number:
650-995-1202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ARGUELLO ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94063-1566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-851-4900
Provider Business Practice Location Address Fax Number:
650-995-1202
Provider Enumeration Date:
11/23/2010

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: 163W00000X , with the licence number:  344442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 19242 , 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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