Healthcare Provider Details

I. General information

NPI: 1982174686
Provider Name (Legal Business Name): ASHLEY JEANINE PAPPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OAK LN
MOUNTAIN VIEW CA
94040-2629
US

IV. Provider business mailing address

36 OAK LN
MOUNTAIN VIEW CA
94040-2629
US

V. Phone/Fax

Practice location:
  • Phone: 650-938-3600
  • Fax:
Mailing address:
  • Phone: 650-938-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: