Healthcare Provider Details

I. General information

NPI: 1386663300
Provider Name (Legal Business Name): INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

IV. Provider business mailing address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-3400
  • Fax: 408-960-7016
Mailing address:
  • Phone: 408-445-3400
  • Fax: 408-960-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number36971
License Number StateCA

VIII. Authorized Official

Name: MS. SONYA TETNOWSKI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 408-445-3400