Healthcare Provider Details

I. General information

NPI: 1306804331
Provider Name (Legal Business Name): LOSGATOS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 DARDANELLI LN STE # 16
LOS GATOS CA
95032-1440
US

IV. Provider business mailing address

320 DARDANELLI LN STE # 16
LOS GATOS CA
95032-1440
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-7830
  • Fax: 408-866-8103
Mailing address:
  • Phone: 408-866-7830
  • Fax: 408-866-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN K BEZECNY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 408-866-7830