Provider Demographics
NPI:1013439942
Name:STARVISTA
Entity Type:Organization
Organization Name:STARVISTA
Other - Org Name:STARVISTA DALY CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-591-9623
Mailing Address - Street 1:610 ELM ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 GELLERT BLVD STE 206
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2659
Practice Address - Country:US
Practice Address - Phone:650-591-9623
Practice Address - Fax:650-591-4163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARVISTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health