Healthcare Provider Details

I. General information

NPI: 1235274044
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ALUM ROCK AVE
SAN JOSE CA
95127-2807
US

IV. Provider business mailing address

3030 ALUM ROCK AVE
SAN JOSE CA
95127-2807
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-3396
  • Fax: 408-254-2383
Mailing address:
  • Phone: 408-254-3396
  • Fax: 408-254-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: REYMUNDO C ESPINOZA
Title or Position: CEO
Credential:
Phone: 408-200-2291