Basic Information
| Provider Information | |||||||||
| NPI: | 1689892390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DVA PALO ALTO HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1273 ALVERNAZ DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951212505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175204425 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3801 MIRANDA AVE | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504935000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOIS | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF PODIATRY | ||||||||
| AuthorizedOfficialTelephone: | 6504935000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | EL1680 | CA | Y | Hospitals | Military Hospital |
No ID Information.