Healthcare Provider Details

I. General information

NPI: 1629236500
Provider Name (Legal Business Name): INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E SANTA CLARA ST SUITE 230
SAN JOSE CA
95112-1908
US

IV. Provider business mailing address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-3400
  • Fax: 408-448-1041
Mailing address:
  • Phone: 408-445-3400
  • Fax: 408-448-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number070000118
License Number StateCA

VIII. Authorized Official

Name: WANDA E EDMO
Title or Position: HUMAN RESOURCE DIRECTOR
Credential:
Phone: 408-445-3400