Healthcare Provider Details

I. General information

NPI: 1124813225
Provider Name (Legal Business Name): SILOETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 MIRAMONTE AVE # A
LOS ALTOS CA
94024-6003
US

IV. Provider business mailing address

1564 MIRAMONTE AVE # A
LOS ALTOS CA
94024-6003
US

V. Phone/Fax

Practice location:
  • Phone: 650-917-1771
  • Fax: 650-917-1551
Mailing address:
  • Phone: 650-917-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name: JOANNE CARRUTH
Title or Position: OWNER/CERTIFIED FITTER
Credential:
Phone: 650-917-1771