Healthcare Provider Details

I. General information

NPI: 1154986107
Provider Name (Legal Business Name): SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 LENZEN AVE RM 105
SAN JOSE CA
95126-2736
US

IV. Provider business mailing address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

V. Phone/Fax

Practice location:
  • Phone: 408-525-4729
  • Fax:
Mailing address:
  • Phone: 408-284-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN HART
Title or Position: COO/CFO
Credential:
Phone: 408-284-2289