Healthcare Provider Details

I. General information

NPI: 1922366186
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 EL CAMINO REAL SUITE 100
ATHERTON CA
94027-3811
US

IV. Provider business mailing address

1621 GOLD STREET
ALVISO CA
95002-1240
US

V. Phone/Fax

Practice location:
  • Phone: 408-200-2291
  • Fax: 408-278-7799
Mailing address:
  • Phone: 408-200-2291
  • Fax: 408-935-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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