Healthcare Provider Details

I. General information

NPI: 1477950681
Provider Name (Legal Business Name): SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

IV. Provider business mailing address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-2280
  • Fax: 408-754-0450
Mailing address:
  • Phone: 408-284-2280
  • Fax: 408-754-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number22065
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN HART
Title or Position: CFO
Credential:
Phone: 408-284-2289