Healthcare Provider Details

I. General information

NPI: 1306344510
Provider Name (Legal Business Name): EL CAMINO HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRANT RD STE 1B20 SUITE 1B20
MOUNTAIN VIEW CA
94040-4302
US

IV. Provider business mailing address

2500 GRANT RD STE 1B20
MOUNTAIN VIEW CA
94040-4378
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-8240
  • Fax: 650-988-8245
Mailing address:
  • Phone: 650-988-8240
  • Fax: 650-988-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55879
License Number StateCA

VIII. Authorized Official

Name: MARIAN TAY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 650-988-8240