Healthcare Provider Details

I. General information

NPI: 1265558324
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 S BASCOM AVE SUITE 100 AND 120
SAN JOSE CA
95128-2651
US

IV. Provider business mailing address

828 S BASCOM AVE SUITE 200
SAN JOSE CA
95128-2651
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-5959
  • Fax:
Mailing address:
  • Phone: 408-885-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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