| Stanford Hospital And Clinics | |
|
300 Pasteur Drive Rm A343 Stanford CA 94305-5235 | |
| (650) 498-7875 | |
| (650) 498-7868 |
| Full Name | Stanford Hospital And Clinics |
|---|---|
| Speciality | Psychologist |
| Location | 300 Pasteur Drive, Stanford, California |
| Authorized Official Name and Position | Mark Burdelle (NEURODIAGNOSTIC LAB MANAGER) |
| Authorized Official Contact | 6507230244 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanford Hospital And Clinics 300 Pasteur Drive Rm A343 Stanford CA 94305-5235 Ph: (650) 498-7875 | Stanford Hospital And Clinics 300 Pasteur Drive Rm A343 Stanford CA 94305-5235 Ph: (650) 498-7875 |
| NPI Number | 1295863405 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295863405 | NPI | - | NPPES |
| PSY124930 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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