Basic Information
| Provider Information | |||||||||
| NPI: | 1316982994 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALO ALTO MEDICAL FOUNDATION/FREMONT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 W EL CAMINO REAL | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940406201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509343529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 KEARNEY ST | ||||||||
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| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104901222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | SLAVIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6509347221 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PALO ALTO MEDICAL FOUNDATION FOR HEALTH CARE, RESEARCH AND EDUCATION | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0262640001 | CA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.