Basic Information
| Provider Information | |||||||||
| NPI: | 1972689156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANFORD MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 HANOVER ST | ||||||||
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| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041117 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 PASTEUR DR | ||||||||
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| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943052200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504985710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | PASQUINELLI | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6504985710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.