Healthcare Provider Details

I. General information

NPI: 1912081548
Provider Name (Legal Business Name): SARATOGA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 SARATOGA AVE
SAN JOSE CA
95129-3402
US

IV. Provider business mailing address

1060 SARATOGA AVE
SAN JOSE CA
95129-3402
US

V. Phone/Fax

Practice location:
  • Phone: 408-243-6911
  • Fax: 408-243-6941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberG21069
License Number StateCA

VIII. Authorized Official

Name: DIRENDIA SHACKELFORD
Title or Position: MANAGED CARE SPECIALIST
Credential:
Phone: 800-654-0889