Healthcare Provider Details

I. General information

NPI: 1013749696
Provider Name (Legal Business Name): MICHELE MICHIKO TANAKA DIAS-ALCOBER RRT, RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE MICHIKO TANAKA DIAS RRT, RCP

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE BLDG 1
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

4426 FENICO TER
FREMONT CA
94536-5627
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 510-996-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number41121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: