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Organization
STANFORD HOSPITAL AND CLINICS
Active
Organization
STANFORD HOSPITAL AND CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BURDELLE (NEURODIAGNOSTIC LAB MANAGER)
(650) 723-0244
Entity
Organization
Contact information
Practice address
300 PASTEUR DRIVE, RM A343, STANFORD, CA 94305-5235
(650) 498-7875
(650) 498-7868
Mailing address
300 PASTEUR DRIVE, RM A343, STANFORD, CA 94305-5235
(650) 498-7875
(650) 498-7868
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY124930
—
CA
Enumeration date
03/01/2007
Last updated
09/11/2025
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