Healthcare Provider Details

I. General information

NPI: 1679928733
Provider Name (Legal Business Name): ERIC SIMON MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 12/20/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HOMESTEAD RD BLDG 2
CUPERTINO CA
95014-0712
US

IV. Provider business mailing address

19000 HOMESTEAD RD BLDG 2
CUPERTINO CA
95014-0712
US

V. Phone/Fax

Practice location:
  • Phone: 408-366-4000
  • Fax:
Mailing address:
  • Phone: 408-366-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA15113
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA15113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: