Healthcare Provider Details

I. General information

NPI: 1821500356
Provider Name (Legal Business Name): UNIVERSITY HEALTHCARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 S WINCHESTER BLVD
SAN JOSE CA
95128-2928
US

IV. Provider business mailing address

PO BOX 742244
LOS ANGELES CA
90074-2244
US

V. Phone/Fax

Practice location:
  • Phone: 408-984-7226
  • Fax: 408-984-7225
Mailing address:
  • Phone: 510-974-8258
  • Fax: 510-974-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE RUSLEN
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 510-974-8297