Healthcare Provider Details

I. General information

NPI: 1295858579
Provider Name (Legal Business Name): JORGE V. CONTRERAS, M.D., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 BLOSSOM HILL RD STE 215
SAN JOSE CA
95123-2704
US

IV. Provider business mailing address

841 BLOSSOM HILL RD STE 215
SAN JOSE CA
95123-2704
US

V. Phone/Fax

Practice location:
  • Phone: 408-629-7095
  • Fax: 408-281-8235
Mailing address:
  • Phone: 408-629-7095
  • Fax: 408-281-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG45510
License Number StateCA

VIII. Authorized Official

Name: JORGE VASQUEZ CONTRERAS
Title or Position: OWNER
Credential: M.D.
Phone: 408-629-7095