Healthcare Provider Details

I. General information

NPI: 1649060526
Provider Name (Legal Business Name): GARDNER FAMILY HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 ALUM ROCK AVE STE 50
SAN JOSE CA
95116-1437
US

IV. Provider business mailing address

160 E VIRGINIA ST HR/CREDENTIALING DEPT STE 100
SAN JOSE CA
95112
US

V. Phone/Fax

Practice location:
  • Phone: 408-457-7015
  • Fax: 408-579-6172
Mailing address:
  • Phone: 408-579-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINA CORNELL
Title or Position: CREENTIALING
Credential:
Phone: 408-579-6178