Healthcare Provider Details

I. General information

NPI: 1457545147
Provider Name (Legal Business Name): MICHAEL HART N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OAK ST
SAN JOSE CA
95110-2817
US

IV. Provider business mailing address

5671 SANTA TERESA BLVD STE 105
SAN JOSE CA
95123-6512
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-0980
  • Fax: 408-993-9833
Mailing address:
  • Phone: 408-284-2281
  • Fax: 408-754-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number430931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: