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General NPI Number Information
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NPI Number | 1831587955
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Entity Type | Organization
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Legal Business Name | ST JUDE HOSPITAL YORBA LINDA
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 108 LYNCH CREEK WAY SUITE 3
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City | PETALUMA
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State | CA
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Zip | 94954-2357
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Country | US
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Telephone | 707-763-7403
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Fax | 707-789-0900
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Provider Business Mailing Address
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Address Line | 279 IMPERIAL HWY SUITE 730
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City | FULLERTON
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State | CA
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Zip | 92835-1041
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Country | US
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Telephone | 714-449-4841
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Fax | 714-449-4956
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | BOB JUST
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Credential |
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Telephone | 707-303-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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