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General NPI Number Information
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NPI Number | 1740445477
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Entity Type | Organization
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Legal Business Name | GARDNER FAMILY CARE
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 160 E VIRGINIA ST #280
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City | SAN JOSE
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State | CA
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Zip | 95112-5857
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Country | US
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Telephone | 408-287-6200
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Fax | 408-998-1535
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Provider Business Mailing Address
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Address Line | 160 E VIRGINIA ST #280
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City | SAN JOSE
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State | CA
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Zip | 95112-5857
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Country | US
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Telephone | 408-287-6200
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Fax | 408-998-1535
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Authorized Official
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Title or Position | QI COORDINATOR
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Name | MS. CECILY ZAZUETA
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Credential | MFT
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Telephone | 408-287-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 52986
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License Number State | CA
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