Healthcare Provider Details

I. General information

NPI: 1174711915
Provider Name (Legal Business Name): CHOICE MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 STONE AVE SUITE 2B
SAN JOSE CA
95125-1306
US

IV. Provider business mailing address

PO BOX 5640
SAN JOSE CA
95150-5640
US

V. Phone/Fax

Practice location:
  • Phone: 408-995-0102
  • Fax: 408-995-6842
Mailing address:
  • Phone: 408-995-0102
  • Fax: 408-995-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. NORMAN FISK
Title or Position: OWNER
Credential: M.D.
Phone: 408-995-0102