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General NPI Number Information
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NPI Number | 1457011736
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Entity Type | Organization
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Legal Business Name | STANFORD EMPLOYER HEALTH CLINICS
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 1189 COLEMAN AVENUE
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City | SAN JOSE
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State | CA
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Zip | 95110
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Country | US
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Telephone | 408-412-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 500 PASTEUR DR RM P388 MC5288
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City | PALO ALTO
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State | CA
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Zip | 94304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CYNTHIA JEAN GULICK
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Credential |
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Telephone | 650-485-9551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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