Healthcare Provider Details

I. General information

NPI: 1316124951
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TULLY RD
SAN JOSE CA
95111-1917
US

IV. Provider business mailing address

PO BOX 103331
PASADENA CA
91189-3331
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-0000
  • Fax:
Mailing address:
  • Phone: 669-299-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number070000085
License Number StateCA

VIII. Authorized Official

Name: PAUL E LORENZ
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 408-885-4010