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General NPI Number Information
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NPI Number | 1154741783
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Entity Type | Organization
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Legal Business Name | TO BE PRIMARY CARE
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 15215 NATIONAL AVE STE 104
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City | LOS GATOS
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State | CA
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Zip | 95032-2425
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Country | US
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Telephone | 707-321-8542
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2266
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City | CUPERTINO
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State | CA
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Zip | 95015-2266
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Country | US
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Telephone | 707-321-8542
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | THAO NGUYEN
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Credential | M.D.
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Telephone | 707-321-8542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A76835
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License Number State | CA
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