Healthcare Provider Details

I. General information

NPI: 1942024245
Provider Name (Legal Business Name): MR. FERDINAND650 D PARCASIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD BLDG 332
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD BLDG 332
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-376-8641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number249835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: