Healthcare Provider Details

I. General information

NPI: 1023161734
Provider Name (Legal Business Name): WELLBOUND OF SAN JOSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S EL CAMINO REAL
SAN MATEO CA
94403-1805
US

IV. Provider business mailing address

300 SANTANA ROW SUITE 300
SAN JOSE CA
95128-2018
US

V. Phone/Fax

Practice location:
  • Phone: 650-377-0882
  • Fax: 650-358-3906
Mailing address:
  • Phone: 650-377-0882
  • Fax: 650-404-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE VINCENT
Title or Position: PRESIDENT/COO
Credential:
Phone: 650-404-3600