Healthcare Provider Details

I. General information

NPI: 1063477503
Provider Name (Legal Business Name): NICOLE HLAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 HIGH ST
PALO ALTO CA
94301-1054
US

IV. Provider business mailing address

221 HIGH ST
PALO ALTO CA
94301-1054
US

V. Phone/Fax

Practice location:
  • Phone: 415-637-2113
  • Fax:
Mailing address:
  • Phone: 415-637-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA87960
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA87960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: