Healthcare Provider Details

I. General information

NPI: 1912072844
Provider Name (Legal Business Name): SANTA CLARA COUNTY CCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 THORNTON WAY
SAN JOSE CA
95128-4713
US

IV. Provider business mailing address

720 EMPEY WAY
SAN JOSE CA
95128-4710
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-5900
  • Fax: 408-793-5975
Mailing address:
  • Phone: 408-793-6200
  • Fax: 408-793-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMMA MENDEZ
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 408-793-6200