Healthcare Provider Details

I. General information

NPI: 1497865976
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 GUADALUPE PKWY SUITE 238
SAN JOSE CA
95110-1714
US

IV. Provider business mailing address

828 SOUTH BASCOM AVENUE SUITE 200
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-299-3166
  • Fax: 408-971-2651
Mailing address:
  • Phone: 408-885-5784
  • Fax: 408-885-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY DANE PENA
Title or Position: DIRECTOR
Credential: PHD
Phone: 408-885-5782