Healthcare Provider Details

I. General information

NPI: 1992247811
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ALEXIAN DR VHC AT ALEXIAN
SAN JOSE CA
95116-1901
US

IV. Provider business mailing address

PO BOX 398407
SAN FRANCISCO CA
94139-8407
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-6050
  • Fax: 408-272-6051
Mailing address:
  • Phone: 408-272-6050
  • Fax: 408-272-6051

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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL E LORENZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 408-885-4004