Healthcare Provider Details

I. General information

NPI: 1851573943
Provider Name (Legal Business Name): ELAINE VAKILI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 TULLY RD
SAN JOSE CA
95111-1048
US

IV. Provider business mailing address

614 TULLY RD
SAN JOSE CA
95111-1048
US

V. Phone/Fax

Practice location:
  • Phone: 408-494-1533
  • Fax: 408-494-1557
Mailing address:
  • Phone: 408-494-1533
  • Fax: 408-494-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number537938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: