Healthcare Provider Details

I. General information

NPI: 1548345770
Provider Name (Legal Business Name): FREDERICK TIMOTHY GUILFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 EL CAMINO REAL #110
LOS ALTOS CA
94022
US

IV. Provider business mailing address

5050 EL CAMINO REAL #110
LOS ALTOS CA
94022
US

V. Phone/Fax

Practice location:
  • Phone: 650-964-6700
  • Fax: 650-964-3495
Mailing address:
  • Phone: 650-964-6700
  • Fax: 650-964-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberC38149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: