Healthcare Provider Details

I. General information

NPI: 1669486700
Provider Name (Legal Business Name): PAUL R CIPRIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE STE 104
SAN JOSE CA
95128
US

IV. Provider business mailing address

105 N BASCOM AVE STE 104
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-0405
  • Fax: 408-918-0409
Mailing address:
  • Phone: 408-918-0405
  • Fax: 408-918-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC35381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberC35381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: