Healthcare Provider Details

I. General information

NPI: 1306259197
Provider Name (Legal Business Name): MIGUEL ANGEL IX VERDUZCO MHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BRYANT AVE
MOUNTAIN VIEW CA
94040-4527
US

IV. Provider business mailing address

3535 TRUMAN AVE
MOUNTAIN VIEW CA
94040-4559
US

V. Phone/Fax

Practice location:
  • Phone: 650-940-4600
  • Fax:
Mailing address:
  • Phone: 650-940-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: