MEDICARE: COUNTY OF SANTA CLARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		CA
2	261QP2300X	Primary Care Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083651152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SANTA CLARA

Provider Business Mailing Address
First Line	:	PO BOX 5280
Second Line	:	PATIENT BUSINESS SERVICES
City	:	SAN JOSE
State	:	CA
Zip	:	95150-5280
Country	:	US
Telephone Number	:	408-885-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 S BASCOM AVE
Second Line	:	MEDICAL MOBILE UNIT-SLS
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2603
Country	:	US
Telephone Number	:	408-885-5000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. ALFONSO F BANUELOS
Credential	:	MD
Telephone Number	:	408-885-4001

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/11/2025

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