Healthcare Provider Details

I. General information

NPI: 1427073444
Provider Name (Legal Business Name): NATHANIEL CARLTON LAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/07/2022
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

V. Phone/Fax

Practice location:
  • Phone: 408-558-2100
  • Fax:
Mailing address:
  • Phone: 408-259-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG82294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: