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General NPI Number Information
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NPI Number | 1477679561
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Entity Type | Organization
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Legal Business Name | DADS-EVTR
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 ALEXIAN DR STE B
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City | SAN JOSE
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State | CA
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Zip | 95116-1901
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Country | US
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Telephone | 408-272-6524
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Fax | 408-272-6590
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Provider Business Mailing Address
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Address Line | 2101 ALEXIAN DR STE B
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City | SAN JOSE
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State | CA
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Zip | 95116-1901
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Country | US
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Telephone | 408-272-6524
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Fax | 408-272-6590
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Authorized Official
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Title or Position | REHABILITATION COUNSELOR
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Name | BENJAMIN PAREDES
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Credential |
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Telephone | 408-272-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 101YA0400X
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License Number State | CA
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