Healthcare Provider Details

I. General information

NPI: 1083454961
Provider Name (Legal Business Name): LOAVES & FISHES FAMILY KITCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 GARLAND AVE
SAN JOSE CA
95126
US

IV. Provider business mailing address

1500 BERGER DR
SAN JOSE CA
95112
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-1294
  • Fax:
Mailing address:
  • Phone: 408-922-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: DAVID HOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 408-922-9284