Healthcare Provider Details

I. General information

NPI: 1750497418
Provider Name (Legal Business Name): PHYLLIS MISAE TEMPO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GREAT OAKS BLVD VA PALO ALTO HEALTH CARE SYSTEM
SAN JOSE CA
95119
US

IV. Provider business mailing address

755 NASH AVE
MENLO PARK CA
94025-2719
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-3000
  • Fax: 408-363-3046
Mailing address:
  • Phone: 650-322-6518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: