Healthcare Provider Details

I. General information

NPI: 1548494834
Provider Name (Legal Business Name): SUTTER WEST BAY MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 S BASCOM AVE #113
SAN JOSE CA
95124-2674
US

IV. Provider business mailing address

PO BOX 254947
SACRAMENTO CA
95865-4947
US

V. Phone/Fax

Practice location:
  • Phone: 408-832-5498
  • Fax: 408-927-5421
Mailing address:
  • Phone: 916-854-6975
  • Fax: 916-854-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN GATES
Title or Position: RCFO
Credential:
Phone: 415-600-7755