Provider Demographics
NPI:1639383193
Name:STANFORD UNIVERSITY
Entity Type:Organization
Organization Name:STANFORD UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGY FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:JAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-641-0333
Mailing Address - Street 1:834 ESPLANADA WAY
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-1015
Mailing Address - Country:US
Mailing Address - Phone:650-641-0333
Mailing Address - Fax:
Practice Address - Street 1:780 WELCH RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1516
Practice Address - Country:US
Practice Address - Phone:650-725-4738
Practice Address - Fax:650-721-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103091282N00000X, 284300000X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No286500000XHospitalsMilitary Hospital