Healthcare Provider Details

I. General information

NPI: 1144472127
Provider Name (Legal Business Name): JONATHAN HUTCHINS GARDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY STE 470
SAN JOSE CA
95119-1138
US

IV. Provider business mailing address

275 HOSPITAL PKWY STE 470
SAN JOSE CA
95119-1138
US

V. Phone/Fax

Practice location:
  • Phone: 669-245-0710
  • Fax:
Mailing address:
  • Phone: 669-245-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA122421
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA122421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: