Healthcare Provider Details

I. General information

NPI: 1922068402
Provider Name (Legal Business Name): LOS OLIVOS WOMEN'S MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/25/2015
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 11855
BELFAST ME
04915-4009
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-4845
  • Fax: 408-358-1602
Mailing address:
  • Phone: 408-358-4845
  • Fax: 408-358-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE L SANDERS
Title or Position: MANAGER
Credential:
Phone: 408-358-4845