Provider Demographics
NPI:1316593965
Name:MICHELLE E PEZZANI, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHELLE E PEZZANI, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-279-5143
Mailing Address - Street 1:650 CASTRO ST STE 120-462
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-2055
Mailing Address - Country:US
Mailing Address - Phone:650-279-5143
Mailing Address - Fax:
Practice Address - Street 1:2500 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4378
Practice Address - Country:US
Practice Address - Phone:650-940-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital