Healthcare Provider Details

I. General information

NPI: 1194804492
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE SCVMC AMBULATORY SURGERY UNIT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

PO BOX 5280 PATIENT BUSINESS SERVICES
SAN JOSE CA
95150-5280
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-885-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALFONSO F BANUELOS JR.
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 408-885-4001