Healthcare Provider Details

I. General information

NPI: 1255425807
Provider Name (Legal Business Name): HEATHER T COUSINS M D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

IV. Provider business mailing address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

V. Phone/Fax

Practice location:
  • Phone: 650-849-0102
  • Fax: 650-858-8905
Mailing address:
  • Phone: 650-849-0102
  • Fax: 650-858-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA85210
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA85210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: