Healthcare Provider Details

I. General information

NPI: 1457544462
Provider Name (Legal Business Name): RONALD S GREENWALD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR BUILDING 15
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR BUILDING 15
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-968-4747
  • Fax: 650-968-8086
Mailing address:
  • Phone: 650-968-4747
  • Fax: 650-968-8086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG56400
License Number StateCA

VIII. Authorized Official

Name: MRS. DIANA I PISTORIUS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 650-968-4747