Healthcare Provider Details

I. General information

NPI: 1871302224
Provider Name (Legal Business Name): JOSE PUENTE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HIGHLAND AVE
SAN MARTIN CA
95046-9504
US

IV. Provider business mailing address

5959 GEMWOOD LOOP SAN JOSE CA 95123
SAN JOSE CA
95123
US

V. Phone/Fax

Practice location:
  • Phone: 408-852-2420
  • Fax:
Mailing address:
  • Phone: 408-771-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number210961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: