Healthcare Provider Details

I. General information

NPI: 1336271964
Provider Name (Legal Business Name): DAVID A SEVERIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY
SAN JOSE CA
95119-1106
US

IV. Provider business mailing address

275 HOSPITAL PKWY MEMORY CLINIC, SUITE 860
SAN JOSE CA
95119-1106
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-6601
  • Fax:
Mailing address:
  • Phone: 408-972-6601
  • Fax: 408-972-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: