1942781083 NPI number — STANFORD BLOOD CENTER, LLC

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 1942781083 NPI number — STANFORD BLOOD CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANFORD BLOOD CENTER, LLC
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:
6
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:
1942781083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3373 HILLVIEW 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:
94304-1274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-723-7994
Provider Business Mailing Address Fax Number:
650-725-4470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3155 PORTER DR
Provider Second Line Business Practice Location Address:
STE 2114-2116
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-724-0100
Provider Business Practice Location Address Fax Number:
650-724-0294
Provider Enumeration Date:
08/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BRANAMAN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
650-723-7886

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF00348233 , 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: 066CA0803 . This is a "THE AMERICAN SOCIETY FOR HISTOCOMPATIBILITY & IMMUNOGENETICS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CLF00348233 . This is a "CLINICAL LABORATORY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D2099675 . This is a "CLIA CERTIFICATE" identifier . This identifiers is of the category "OTHER".




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