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General NPI Number Information
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NPI Number | 1720600612
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Entity Type | Organization
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Legal Business Name | CELL-ED
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 855 EL CAMINO REAL STE 13A-212
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City | PALO ALTO
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State | CA
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Zip | 94301-2305
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Country | US
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Telephone | 650-444-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 855 EL CAMINO REAL STE 13A-212
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City | PALO ALTO
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State | CA
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Zip | 94301-2305
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Country | US
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Telephone | 650-444-6069
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | AMY DAVIS - BRUNER
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Credential | MS,PCC
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Telephone | 509-956-8354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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