Healthcare Provider Details

I. General information

NPI: 1306902150
Provider Name (Legal Business Name): JAMES A CISCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CRANE STREET
MENLO PARK CA
94025-4429
US

IV. Provider business mailing address

PO BOX 60000 FILE # 72484
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG26973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: