Provider Demographics
NPI:1184077497
Name:PALO ALTO MEDICAL FOUNDATION
Entity type:Organization
Organization Name:PALO ALTO MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-934-3526
Mailing Address - Street 1:795 EL CAMINO REAL
Mailing Address - Street 2:LEVEL 1, JAMPLIS BUILDING
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:LEVEL 1, JAMPLIS BUILDING
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-853-2904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 66546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty