Healthcare Provider Details

I. General information

NPI: 1659547461
Provider Name (Legal Business Name): NORTHERN CALIFORNIA KIDNEY STONE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 LARK AVE STE 100
LOS GATOS CA
95032-2547
US

IV. Provider business mailing address

16400 LARK AVE STE 100
LOS GATOS CA
95032-2547
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-2805
  • Fax: 408-358-2810
Mailing address:
  • Phone: 408-358-2805
  • Fax: 408-358-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. FARZANEH TABRIZI
Title or Position: DIRECTOR
Credential: MD
Phone: 408-358-2805