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General NPI Number Information
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NPI Number | 1649060526
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Entity Type | Organization
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Legal Business Name | GARDNER FAMILY HEALTH NETWORK
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1783 ALUM ROCK AVE STE 50
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City | SAN JOSE
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State | CA
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Zip | 95116-1437
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Country | US
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Telephone | 408-457-7015
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Fax | 408-579-6172
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Provider Business Mailing Address
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Address Line | 160 E VIRGINIA ST HR/CREDENTIALING DEPT STE 100
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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 | 408-579-6178
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Fax |
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Authorized Official
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Title or Position | CREENTIALING
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Name | CHRISTINA CORNELL
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Credential |
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Telephone | 408-579-6178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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