Healthcare Provider Details

I. General information

NPI: 1699841528
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST
SAN JOSE CA
95112-5857
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-6200
  • Fax: 408-579-6131
Mailing address:
  • Phone: 408-287-6200
  • Fax: 408-579-6131

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA CORNELL
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 408-579-6178