Healthcare Provider Details

I. General information

NPI: 1144675851
Provider Name (Legal Business Name): TATIANA MEFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2016
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 QUARRY RD
PALO ALTO CA
94304-1419
US

IV. Provider business mailing address

401 QUARRY RD RM 2206
STANFORD CA
94305-4364
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA151397
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA151397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: