Basic Information
| Provider Information | |||||||||
| NPI: | 1417173204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAVAHCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 YALE RD | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940255227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503220211 | ||||||||
| FaxNumber: | 6504962573 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 MIRANDA AVE | ||||||||
| Address2: | (123) | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
| FaxNumber: | 6504962573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMASOL | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINSTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6504935000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | RN271154 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.