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General NPI Number Information
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NPI Number | 1295863405
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Entity Type | Organization
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Legal Business Name | STANFORD HOSPITAL AND CLINICS
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 300 PASTEUR DRIVE RM A343
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City | STANFORD
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State | CA
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Zip | 94305-5235
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Country | US
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Telephone | 650-498-7875
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Fax | 650-498-7868
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Provider Business Mailing Address
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Address Line | 300 PASTEUR DRIVE RM A343
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City | STANFORD
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State | CA
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Zip | 94305-5235
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Country | US
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Telephone | 650-498-7875
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Fax | 650-498-7868
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Authorized Official
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Title or Position | NEURODIAGNOSTIC LAB MANAGER
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Name | MARK BURDELLE
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Credential |
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Telephone | 650-723-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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