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General NPI Number Information
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NPI Number | 1073699609
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Entity Type | Organization
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Legal Business Name | SAN JOSE MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2585 SAMARITAN DR
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City | SAN JOSE
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State | CA
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Zip | 95124-4107
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Country | US
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Telephone | 408-357-1020
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Fax | 408-357-1298
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Provider Business Mailing Address
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Address Line | 400 RACE ST
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City | SAN JOSE
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State | CA
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Zip | 95126-3518
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Country | US
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Telephone | 408-278-3121
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Fax | 408-278-3194
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. ERNIE ANGEL WALLERSTEIN
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Credential |
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Telephone | 408-278-3015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State | CA
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