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General NPI Number Information
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NPI Number | 1306917745
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Entity Type | Organization
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Legal Business Name | SAN JOSE MEDICAL SUPPLY CO INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 283 EAST BROKAW ROAD
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City | SAN JOSE
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State | CA
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Zip | 95112
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Country | US
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Telephone | 408-573-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 283 EAST BROKAW ROAD
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City | SAN JOSE
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State | CA
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Zip | 95112
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Country | US
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Telephone | 408-573-7200
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. JESSICA SANTA ANA
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Credential |
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Telephone | 408-573-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 100890
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License Number State | CA
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