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General NPI Number Information
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NPI Number | 1275964488
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Entity Type | Organization
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Legal Business Name | INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1118 MERIDIAN AVE STE 150
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City | SAN JOSE
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State | CA
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Zip | 95125-4329
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Country | US
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Telephone | 408-445-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 MERIDIAN AVE
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City | SAN JOSE
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State | CA
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Zip | 95125-5212
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Country | US
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Telephone | 408-445-3400
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Fax | 408-448-1727
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DR. ALDON WAYNE SCOTT
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Credential | DM
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Telephone | 408-445-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 070000482
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 070000118
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License Number State | CA
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