Healthcare Provider Details

I. General information

NPI: 1659431302
Provider Name (Legal Business Name): SEONI JOANNA LLANES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR RM H3109 NEUROLOGY AND NEUROLOGICAL SERVICES
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR RM H3109 NEUROLOGY AND NEUROLOGICAL SERVICES
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7875
  • Fax: 650-498-7868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY20364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: