Healthcare Provider Details

I. General information

NPI: 1508131343
Provider Name (Legal Business Name): LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
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: 650-497-8800
  • Fax: 650-497-8034
Mailing address:
  • Phone: 650-497-8800
  • Fax: 650-497-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number1073564571
License Number StateCA

VIII. Authorized Official

Name: MRS. STACIE O. ROHOVIT
Title or Position: NNP SUPERVISOR
Credential: RN, MS, NNP-BC
Phone: 650-497-8800