Healthcare Provider Details

I. General information

NPI: 1083654545
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 GOLD STREET
ALVISO CA
95002-1240
US

IV. Provider business mailing address

PO BOX 1240 1621 GOLD STREET
ALVISO CA
95002-1240
US

V. Phone/Fax

Practice location:
  • Phone: 408-935-3933
  • Fax: 408-935-3988
Mailing address:
  • Phone: 408-935-3933
  • Fax: 408-935-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000152
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000045
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000179
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000007
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000481
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberFHC70262F
License Number StateCA

VIII. Authorized Official

Name: OFELIA RUIZ
Title or Position: DIRECTOR
Credential:
Phone: 408-935-3971