=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841591773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANFORD UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2010
-----------------------------------------------------
Last Update Date | 11/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 PASTEUR DR # H3680
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-5655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-725-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 PASTEUR DR # H3680
-----------------------------------------------------
City | STANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94305-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-725-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSOCIATE
-----------------------------------------------------
Name | MR. DAVID PRESTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-725-9777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number | A112180
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------