Provider Demographics
NPI:1083994768
Name:STANFORD HOSPITAL & CLINICS
Entity Type:Organization
Organization Name:STANFORD HOSPITAL & CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PALLIATIVE CARE PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:PASSAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS
Authorized Official - Phone:650-723-3736
Mailing Address - Street 1:300 PASTEUR DR RM HCO29
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-3736
Mailing Address - Fax:650-723-0927
Practice Address - Street 1:300 PASTEUR DR RM HCO29
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-3736
Practice Address - Fax:650-723-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB258161281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital