Healthcare Provider Details

I. General information

NPI: 1639275753
Provider Name (Legal Business Name): SILICON VALLEY PEDIATRICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR 607
SAN JOSE CA
95124-4006
US

IV. Provider business mailing address

2505 SAMARITAN DR 607
SAN JOSE CA
95124-4006
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-9900
  • Fax: 408-356-9939
Mailing address:
  • Phone: 408-356-9900
  • Fax: 408-356-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF66797
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTINE CUTLER HALABURKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-356-9900