Organization
FACIAL RECONSTRUCTIVE SURGICAL AND MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN S. ODERIO (OFFICE MANAGER)
(650) 328-0511
Entity
Organization
Contact information
Practice address
750 WELCH RD., SUITE 317, PALO ALTO, CA 94304-1510
(650) 328-0511
(650) 328-3419
Mailing address
750 WELCH RD., SUITE 317, PALO ALTO, CA 94304-1510
(650) 328-0511
(650) 328-3419
Taxonomy
Speciality
Code
Description
License number
State
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4021229
COMMERCIAL #
CA
Enumeration date
03/06/2007
Last updated
08/22/2020
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