Basic Information
| Provider Information | |||||||||
| NPI: | 1619034105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL CAMINO HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 GRANT RD | ||||||||
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| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940404302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2240 TULLY RD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951221347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509407000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| 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 | 261QE0700X | 070000660 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.