Healthcare Provider Details

I. General information

NPI: 1659756187
Provider Name (Legal Business Name): STANFORD HOSPITAL AND CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-888-9524
  • Fax:
Mailing address:
  • Phone: 650-888-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number95001605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number95001605
License Number StateCA

VIII. Authorized Official

Name: DR. BRUNO MEDEIROS
Title or Position: SUPERVISING PHYSICIAN
Credential: MD
Phone: 650-724-4394