Basic Information
| Provider Information | |||||||||
| NPI: | 1972970499 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARVISTA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 610 ELM ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940708401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505919623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 ELM ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940708401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505919623 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2015 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | CATAN | ||||||||
| AuthorizedOfficialFirstName: | HOPE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MFTT | ||||||||
| AuthorizedOfficialTelephone: | 6505919623 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.