Healthcare Provider Details

I. General information

NPI: 1689641797
Provider Name (Legal Business Name): HOSPITAL DRIVE PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR BLDG 12
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR BLDG 12
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-968-6033
  • Fax: 650-968-4542
Mailing address:
  • Phone: 650-968-6033
  • Fax: 650-968-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA MCPHERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 650-968-6033