Basic Information
| Provider Information | |||||||||
| NPI: | 1457594087 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL CAMINO HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 GRANT RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940404302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 KNOWLES DR | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | WOO | ||||||||
| AuthorizedOfficialFirstName: | MING-RONG | ||||||||
| AuthorizedOfficialMiddleName: | CHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REV & REIMB | ||||||||
| AuthorizedOfficialTelephone: | 6509407247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 070000660 | DE | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP30308H | 05 | CA | MEDICAID | HSC30308H | 05 | CA | MEDICAID | HSP40308H | 05 | CA | MEDICAID | LTC55593F | 05 | CA | MEDICAID | ZZZA43042 | 01 | CA | BLUE SHIELD | OTHER | CDC02659G | 05 | CA | MEDICAID | PBH35400 | 05 | CA | MEDICAID |