Healthcare Provider Details

I. General information

NPI: 1265898357
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7526 MONTEREY ST
GILROY CA
95020-5826
US

IV. Provider business mailing address

160 E VIRGINIA ST SUITE 100
SAN JOSE CA
95112-5857
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-9400
  • Fax:
Mailing address:
  • Phone: 408-918-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number63902
License Number StateCA

VIII. Authorized Official

Name: MRS. LORENA ORTIZ
Title or Position: CREDENTIALLING SPECIALIST
Credential:
Phone: 408-918-2618