Healthcare Provider Details

I. General information

NPI: 1386041945
Provider Name (Legal Business Name): PALO ALTO VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 COLEMAN AVE APARTMENT 18
MENLO PARK CA
94025-2450
US

IV. Provider business mailing address

808 COLEMAN AVE APARTMENT 18
MENLO PARK CA
94025-2450
US

V. Phone/Fax

Practice location:
  • Phone: 571-265-9715
  • Fax:
Mailing address:
  • Phone: 571-265-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA129357
License Number StateCA

VIII. Authorized Official

Name: DR. NILOY DASGUPTA
Title or Position: FEE BASIS RADIOLOGIST
Credential:
Phone: 571-265-9715