1750497418 NPI number — MS. PHYLLIS MISAE TEMPO MSW

Table of content: MS. PHYLLIS MISAE TEMPO MSW (NPI 1750497418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750497418 NPI number — MS. PHYLLIS MISAE TEMPO MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEMPO
Provider First Name:
PHYLLIS
Provider Middle Name:
MISAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1750497418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 NASH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-322-6518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GREAT OAKS BLVD
Provider Second Line Business Practice Location Address:
VA PALO ALTO HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-363-3000
Provider Business Practice Location Address Fax Number:
408-363-3046
Provider Enumeration Date:
08/22/2006

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: 1041C0700X , with the licence number:  LCS15616 , 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: LCS15616 . This is a "LICENSED CLINICAL SW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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