Healthcare Provider Details

I. General information

NPI: 1265096283
Provider Name (Legal Business Name): PAIGE M WEISBROD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20730 VALLEY GREEN DR
CUPERTINO CA
95014-1704
US

IV. Provider business mailing address

841 W CALIFORNIA AVE UNIT E
SUNNYVALE CA
94086-2491
US

V. Phone/Fax

Practice location:
  • Phone: 408-783-4000
  • Fax:
Mailing address:
  • Phone: 925-339-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: