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General NPI Number Information
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NPI Number | 1306156336
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Entity Type | Organization
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Legal Business Name | COUNTY OF SANTA CLARA
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 143 S MAIN ST
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City | MILPITAS
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State | CA
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Zip | 95035-5302
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Country | US
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Telephone | 408-885-2300
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Fax | 408-885-5822
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Provider Business Mailing Address
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Address Line | 751 S BASCOM AVE BUILDING W
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City | SAN JOSE
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State | CA
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Zip | 95128-2604
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Country | US
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Telephone | 408-885-2300
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Fax | 408-885-5822
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. ALFONSO F BANUELOS JR.
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Credential | MD
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Telephone | 408-885-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 50182
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License Number State | CA
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