Healthcare Provider Details

I. General information

NPI: 1154374411
Provider Name (Legal Business Name): MEI-VEN C LO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

PO BOX 84294
SEATTLE WA
98124-5594
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax: 408-928-7041
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG66296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: