Healthcare Provider Details

I. General information

NPI: 1891915005
Provider Name (Legal Business Name): OSTEOPOROSIS CENTER OF SAN JOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N 14TH ST STE 890
SAN JOSE CA
95112-6216
US

IV. Provider business mailing address

25 N. 14TH ST. SUITE 890
SAN JOSE CA
95112
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-6694
  • Fax: 408-288-6698
Mailing address:
  • Phone: 408-288-6694
  • Fax: 408-288-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License NumberRHC142268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberFAC52131
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE J DREYFUSS
Title or Position: DIRECTOR
Credential: MD
Phone: 408-288-6694