=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477977973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD MAR MONTE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2014
-----------------------------------------------------
Last Update Date | 07/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2907 EL CAMINO REAL
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94061-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-235-7940
-----------------------------------------------------
Fax | 650-235-7978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1691 THE ALAMEDA
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95126-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-795-3619
-----------------------------------------------------
Fax | 408-287-0405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | TOM MOTSIFF
-----------------------------------------------------
Credential | MHA,CMA
-----------------------------------------------------
Telephone | 408-795-3707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------