Provider Demographics
NPI:1790368702
Name:SPRINTER MEDICAL WEST PC
Entity Type:Organization
Organization Name:SPRINTER MEDICAL WEST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLIVALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:669-232-0803
Mailing Address - Street 1:2375 MONTPELIER DR STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1627
Mailing Address - Country:US
Mailing Address - Phone:669-232-0803
Mailing Address - Fax:
Practice Address - Street 1:4600 BOHANNON DR STE 100
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1037
Practice Address - Country:US
Practice Address - Phone:925-322-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty