Provider Demographics
NPI:1407964638
Name:SPERA, KEVIN V (PMHCNS, BC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:V
Last Name:SPERA
Suffix:
Gender:M
Credentials:PMHCNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-369-1383
Practice Address - Street 1:2300 CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:415-369-1383
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95044800163W00000X
CAPMH586163WP0808X
CACNS4252364S00000X
CA0240982364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPMH586OtherSTATE MEDICAL LICENSE
CACNS4252OtherSTATE MEDICAL LICENSE
CARN95044800OtherSTATE MEDICAL LICENSE