1093083628 NPI number — DR. SANDRA EVELYN PELTZ PHARMD

Table of content: DR. SANDRA EVELYN PELTZ PHARMD (NPI 1093083628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093083628 NPI number — DR. SANDRA EVELYN PELTZ PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELTZ
Provider First Name:
SANDRA
Provider Middle Name:
EVELYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093083628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 DANBURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94061-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-367-0431
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 COLEMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95050-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-988-0565
Provider Business Practice Location Address Fax Number:
408-567-9061
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  37471 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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