Healthcare Provider Details

I. General information

NPI: 1376828947
Provider Name (Legal Business Name): ACCI/CST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE
SAN JOSE CA
95128-2631
US

IV. Provider business mailing address

555 S PARK VICTORIA DR APT 315
MILPITAS CA
95035-6434
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax: 408-975-2745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ARMINA HUSIC
Title or Position: PROGRAMM MANAGER
Credential:
Phone: 408-975-2730