Healthcare Provider Details

I. General information

NPI: 1245460880
Provider Name (Legal Business Name): VERNA LEE STIVENDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564A MIRAMONTE AVE
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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. LLEE STIVENDER
Title or Position: OWNER MASTECTOMY CERT FITTER AND CO
Credential:
Phone: 650-917-1771