Healthcare Provider Details

I. General information

NPI: 1750121612
Provider Name (Legal Business Name): LOAVES & FISHES FAMILY KITCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 RACE ST
SAN JOSE CA
95126
US

IV. Provider business mailing address

1500 BERGER DR
SAN JOSE CA
95112
US

V. Phone/Fax

Practice location:
  • Phone: 408-961-9845
  • Fax:
Mailing address:
  • Phone: 408-922-9085
  • Fax:

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 Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID HOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 408-922-9284