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General NPI Number Information
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NPI Number | 1871302224
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Entity Type | Individual
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Provider Name | JOSE PUENTE JR.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 90 HIGHLAND AVE
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City | SAN MARTIN
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State | CA
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Zip | 95046-9504
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Country | US
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Telephone | 408-852-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 5959 GEMWOOD LOOP SAN JOSE CA 95123
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City | SAN JOSE
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State | CA
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Zip | 95123
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Country | US
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Telephone | 408-771-3740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 210961
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License Number State | CA
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