Basic Information
| Provider Information | |||||||||
| NPI: | 1457662892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STARVISTA WOMEN'S ENRICHMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 ELM ST STE 212 | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940703070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505919623 | ||||||||
| FaxNumber: | 6505914163 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 QUARRY RD | ||||||||
| Address2: | |||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940706217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505913636 | ||||||||
| FaxNumber: | 6505913600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | DOHERTY | ||||||||
| AuthorizedOfficialFirstName: | LILLIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RECOURCES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6505919623 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.