Healthcare Provider Details

I. General information

NPI: 1881999217
Provider Name (Legal Business Name): SOUTH BAY HOUSE-CALL DOCTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 MIGNON DR
SAN JOSE CA
95132-2118
US

IV. Provider business mailing address

2683 MIGNON DR
SAN JOSE CA
95132-2118
US

V. Phone/Fax

Practice location:
  • Phone: 408-835-9977
  • Fax: 800-818-0931
Mailing address:
  • Phone: 408-835-9977
  • Fax: 800-818-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8549
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number20A8549
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A8549
License Number StateCA

VIII. Authorized Official

Name: DR. VINCENT LE
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 408-835-9977