Provider Demographics
NPI:1982845186
Name:SUTTER BAY MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER BAY MEDICAL FOUNDATION
Other - Org Name:PALO ALTO MEDICAL FOUNDATION FOR HEALTH CARE, RESEARCH & EDUCATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GEGIONAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7347
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E EL CAMINO REAL
Practice Address - Street 2:SUITE 1 NORTHWEST
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-404-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical