Healthcare Provider Details

I. General information

NPI: 1346959749
Provider Name (Legal Business Name): REBUILDING TOGETHER SILICON VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 7TH ST STE 10
SAN JOSE CA
95112-6000
US

IV. Provider business mailing address

1701 S 7TH ST STE 10
SAN JOSE CA
95112-6000
US

V. Phone/Fax

Practice location:
  • Phone: 408-578-9519
  • Fax:
Mailing address:
  • Phone: 408-578-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: DEANNE EVERTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-578-9519