Healthcare Provider Details

I. General information

NPI: 1144713215
Provider Name (Legal Business Name): CARA TERESE PICCOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 650-497-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT215441
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA189884
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA189884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: