Healthcare Provider Details

I. General information

NPI: 1467399725
Provider Name (Legal Business Name): MARTY JOHN FOZ ANDRES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 DREXEL WAY
SAN JOSE CA
95121-2712
US

IV. Provider business mailing address

1078 DREXEL WAY
SAN JOSE CA
95121-2712
US

V. Phone/Fax

Practice location:
  • Phone: 408-477-6286
  • Fax:
Mailing address:
  • Phone: 408-477-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number54561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: