Provider Demographics
NPI:1053844647
Name:STANFORD HEALTH CARE
Entity Type:Organization
Organization Name:STANFORD HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-725-1074
Mailing Address - Street 1:1804 EMBARCADERO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3341
Mailing Address - Country:US
Mailing Address - Phone:650-498-5793
Mailing Address - Fax:
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-373-4601
Practice Address - Fax:925-373-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000662207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty