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General NPI Number Information
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NPI Number | 1124741095
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Entity Type | Organization
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Legal Business Name | ACUTE BEHAVIORAL MEDICAL GROUP OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 2425 SAMARITAN DR
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City | SAN JOSE
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State | CA
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Zip | 95124-3908
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Country | US
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Telephone | 408-559-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 NW 136TH AVE BLDG. H, SUITE 100
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City | SUNRISE
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State | FL
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Zip | 33323-2857
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Country | US
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Telephone | 954-377-2909
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Fax | 865-560-7089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GONZALO PEREZ-GARCIA
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Credential | MD
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Telephone | 354-377-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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