Healthcare Provider Details

I. General information

NPI: 1790112522
Provider Name (Legal Business Name): CALIFORNIA IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E SANTA CLARA ST SUITE 950
SAN JOSE CA
95113-1827
US

IV. Provider business mailing address

75 E SANTA CLARA ST SUITE 950
SAN JOSE CA
95113-1827
US

V. Phone/Fax

Practice location:
  • Phone: 408-929-5610
  • Fax:
Mailing address:
  • Phone: 408-929-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN NGA NGUYEN
Title or Position: COO
Credential:
Phone: 408-929-5610