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General NPI Number Information
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NPI Number | 1376179309
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Entity Type | Organization
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Legal Business Name | SOUTH BAY MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/21/2020
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Last Update Date | 03/21/2020
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Provider Practice Location Address
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Address Line | 16400 LARK AVE STE 350
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City | LOS GATOS
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State | CA
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Zip | 95032-2560
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Country | US
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Telephone | 408-384-9717
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Fax |
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Provider Business Mailing Address
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Address Line | 16400 LARK AVE STE 100
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City | LOS GATOS
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State | CA
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Zip | 95032-2563
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Country | US
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Telephone | 408-515-4699
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Fax |
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | ALI MOAYED
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Credential |
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Telephone | 408-515-4699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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