Healthcare Provider Details

I. General information

NPI: 1730490194
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 ENBORG CT
SAN JOSE CA
95128-2645
US

IV. Provider business mailing address

777 TURNER DR STE 330
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-2300
  • Fax: 408-885-5822
Mailing address:
  • Phone: 408-885-2300
  • Fax: 408-885-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHE 47456
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFONSO F BANUELOS JR.
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 408-885-4001