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General NPI Number Information
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NPI Number | 1134679103
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Entity Type | Organization
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Legal Business Name | THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 866 CAMPUS DR
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City | STANFORD
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State | CA
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Zip | 94305-8508
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Country | US
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Telephone | 650-725-1366
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Fax | 650-723-4999
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Provider Business Mailing Address
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Address Line | 866 CAMPUS DR
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City | STANFORD
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State | CA
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Zip | 94305-8508
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Country | US
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Telephone | 650-725-1366
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Fax | 650-723-4999
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Authorized Official
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Title or Position | DIRECTOR, FINANCE & ADMINISTRATION
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Name | LEIGH SCOTT STACY
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Credential |
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Telephone | 650-725-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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