Healthcare Provider Details

I. General information

NPI: 1699041566
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E. SANTA CLARA STREET
SAN JOSE CA
95112-1900
US

IV. Provider business mailing address

160 E. VIRGINIA STREET SUITE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-2682
  • Fax: 408-278-7799
Mailing address:
  • Phone: 408-918-2682
  • Fax: 408-278-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OFELIA RUIZ
Title or Position: DIRECTOR
Credential:
Phone: 408-935-3971