Healthcare Provider Details

I. General information

NPI: 1821341298
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 ENBORG CT
SAN JOSE CA
95128-2645
US

IV. Provider business mailing address

PO BOX 398407
SAN FRANCISCO CA
94139-8407
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5770
  • Fax:
Mailing address:
  • Phone: 408-885-7354
  • Fax: 408-885-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number07000008F
License Number StateCA

VIII. Authorized Official

Name: JEFFREY L ARNOLD
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 408-885-4001