Healthcare Provider Details

I. General information

NPI: 1174923684
Provider Name (Legal Business Name): PLANNED PARENTHOOD MAR MONTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 A STREET
HAYWARD CA
94541-4106
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 510-300-3800
  • Fax: 510-300-3850
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2510
License Number StateCA

VIII. Authorized Official

Name: MR. TOM MOTSIFF
Title or Position: CFO
Credential: MHA, CMA
Phone: 408-795-3707