Healthcare Provider Details

I. General information

NPI: 1235022211
Provider Name (Legal Business Name): HAZEL MARIE ALBAY SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE BLDG W
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE BLDG W
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-7233
  • Fax:
Mailing address:
  • Phone: 408-793-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95312566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: