Healthcare Provider Details

I. General information

NPI: 1417489691
Provider Name (Legal Business Name): LAURA SILVESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 POTRERO DR
SAN JOSE CA
95124-1649
US

IV. Provider business mailing address

PO BOX 54165
SAN JOSE CA
95154-0165
US

V. Phone/Fax

Practice location:
  • Phone: 408-813-3923
  • Fax:
Mailing address:
  • Phone: 408-813-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114052
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: