1811022775 NPI number — LIZA BATHORI PSY.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811022775 NPI number — LIZA BATHORI PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATHORI
Provider First Name:
LIZA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVENS
Provider Other First Name:
LIZA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811022775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
467 HAMILTON AVE
Provider Second Line Business Mailing Address:
SUITE 22
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94301-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-323-1676
Provider Business Mailing Address Fax Number:
650-323-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 S WINCHESTER BLVD
Provider Second Line Business Practice Location Address:
SUITE C-120
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-654-9311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

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:  PSY#20160 , 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: EIN:94-3120231 . This is a "EASTER SEALS BAY AREA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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