Provider Demographics
NPI:1073998647
Name:STANFORD CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:STANFORD CHILDREN'S HOSPITAL
Other - Org Name:LUCILE PACKARD CHILDREN'S HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEASE
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, MS, LCG
Authorized Official - Phone:650-725-7345
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:MC 5652
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-723-5198
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:MC 5652
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-723-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000656282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital