Healthcare Provider Details

I. General information

NPI: 1841000684
Provider Name (Legal Business Name): OPPORTUNITIES FOR CHANGE OFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 FRUITDALE AVE
SAN JOSE CA
95128-3430
US

IV. Provider business mailing address

4024 CRANDALL CIR
SANTA CLARA CA
95054-4190
US

V. Phone/Fax

Practice location:
  • Phone: 323-495-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: TERRELL PINA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-495-8051