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General NPI Number Information
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NPI Number | 1114477452
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Entity Type | Organization
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Legal Business Name | SILICON VALLEY TMS OF MONTEREY BAY
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 2425 PORTER ST SUITE 11
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City | SOQUEL
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State | CA
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Zip | 95073-2444
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Country | US
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Telephone | 831-296-5700
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Fax | 831-296-5701
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Provider Business Mailing Address
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Address Line | 2425 PORTER ST
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City | SOQUEL
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State | CA
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Zip | 95073-2444
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Country | US
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Telephone | 831-296-5700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PRESIDENT, TREASURER
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Name | ELLIOTT RICHELSON
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Credential | M.D.
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Telephone | 252-733-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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