Healthcare Provider Details

I. General information

NPI: 1124573605
Provider Name (Legal Business Name): DONNA J PASSAGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E CALAVERAS BLVD
MILPITAS CA
95035-5491
US

IV. Provider business mailing address

87 PANORAMIC WAY
WALNUT CREEK CA
94595-1605
US

V. Phone/Fax

Practice location:
  • Phone: 408-945-2900
  • Fax:
Mailing address:
  • Phone: 562-708-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: