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General NPI Number Information
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NPI Number | 1396913349
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Entity Type | Organization
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Legal Business Name | STARLIGHT ADOLESCENT CENTER
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 5824 CHRIS DR
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City | SAN JOSE
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State | CA
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Zip | 95123-3501
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Country | US
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Telephone | 408-224-4458
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Fax | 408-224-4458
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Provider Business Mailing Address
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Address Line | 5824 CHRIS DR
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City | SAN JOSE
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State | CA
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Zip | 95123-3501
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Country | US
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Telephone | 408-224-4458
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Fax | 408-224-4458
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Authorized Official
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Title or Position | LICENSED VOCATIONAL NURSE
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Name | ABU TORAB ZAKIR
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Credential |
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Telephone | 408-224-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | VN 231676
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License Number State | CA
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