Provider Demographics
NPI:1063834943
Name:LUCILE PACKARD CHILDRENS HOSPITAL
Entity type:Organization
Organization Name:LUCILE PACKARD CHILDRENS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-736-7233
Mailing Address - Street 1:730 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1503
Practice Address - Country:US
Practice Address - Phone:650-736-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUCILE PACKARD CHILDRENS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren