Healthcare Provider Details

I. General information

NPI: 1023976511
Provider Name (Legal Business Name): SAN JOSE CONSERVATION CORPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SENTER RD
SAN JOSE CA
95111-1121
US

IV. Provider business mailing address

1560 BERGER DR
SAN JOSE CA
95112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MAES
Title or Position: VICE PRESIDENT OF EDUCATION
Credential:
Phone: 408-595-3503