Healthcare Provider Details

I. General information

NPI: 1275039893
Provider Name (Legal Business Name): UNIVERSITY HEALTHCARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 NATIONAL AVE
LOS GATOS CA
95032-2627
US

IV. Provider business mailing address

PO BOX 742244
LOS ANGELES CA
90074-2244
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-0431
  • Fax:
Mailing address:
  • Phone: 888-924-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE RUSLEN
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 510-974-8297