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General NPI Number Information
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NPI Number | 1932379021
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Entity Type | Organization
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Legal Business Name | SANTA CLARA COUNTY
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 2425 ENBORG LN
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City | SAN JOSE
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State | CA
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Zip | 95128-2648
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Country | US
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Telephone | 408-885-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 ENBORG LN
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City | SAN JOSE
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State | CA
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Zip | 95128-2648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARK STANFORD
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Credential | PHD
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Telephone | 408-885-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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