Healthcare Provider Details

I. General information

NPI: 1235803941
Provider Name (Legal Business Name): SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WOOL CREEK DR
SAN JOSE CA
95112-2617
US

IV. Provider business mailing address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-6051
  • Fax:
Mailing address:
  • Phone: 408-284-2280
  • Fax: 408-754-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN HART
Title or Position: COO/CFO
Credential:
Phone: 408-284-2289