=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033448931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABOUT WOMEN'S HEALTH MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2009
-----------------------------------------------------
Last Update Date | 12/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15251 NATIONAL AVE STE 104
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-7360
-----------------------------------------------------
Fax | 408-358-7357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15251 NATIONAL AVE STE 104
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-7360
-----------------------------------------------------
Fax | 408-358-7357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CATHERINE GRELLET
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 408-358-7360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | G55508
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------