Provider Demographics
NPI:1043654486
Name:SUTTER BAY MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER BAY MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VILARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-934-3526
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:CREDENTIALING DEPT, 2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:650-934-3526
Mailing Address - Fax:
Practice Address - Street 1:2581 SAMARITAN DR
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4113
Practice Address - Country:US
Practice Address - Phone:408-876-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-27
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical