Healthcare Provider Details

I. General information

NPI: 1043263189
Provider Name (Legal Business Name): PLANNED PARENTHOOD MAR MONTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 408-795-3600
  • Fax: 408-971-6963
Mailing address:
  • Phone: 408-795-3600
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberCLN 436
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number070000101
License Number StateCA

VIII. Authorized Official

Name: MR. TOM MOTSIFF
Title or Position: CFO
Credential: MHA,CMA
Phone: 408-795-3707