Healthcare Provider Details

I. General information

NPI: 1174641526
Provider Name (Legal Business Name): RICHARD TWOY RN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE STE 410
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE STE 410
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-2540
  • Fax: 408-885-3016
Mailing address:
  • Phone: 408-793-2540
  • Fax: 408-885-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68585
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number16519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: