Healthcare Provider Details

I. General information

NPI: 1396808119
Provider Name (Legal Business Name): MRS. MANDY VOSSOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3000
  • Fax: 408-972-7153
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: