Healthcare Provider Details

I. General information

NPI: 1366813578
Provider Name (Legal Business Name): VANDA CLARECE MCCAULEY CERT HAIR LOSS SPEC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 GLENBURRY WAY
SAN JOSE CA
95123-1321
US

IV. Provider business mailing address

5377 GLENBURRY WAY
SAN JOSE CA
95123-1321
US

V. Phone/Fax

Practice location:
  • Phone: 408-224-1224
  • Fax: 408-224-1224
Mailing address:
  • Phone: 408-224-1224
  • Fax: 408-224-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: