MEDICARE: PLANNED PARENTHOOD MAR MONTE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	030000075	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174579957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANNED PARENTHOOD MAR MONTE, INC

Provider Business Mailing Address
First Line	:	1691 THE ALAMEDA
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2203
Country	:	US
Telephone Number	:	408-795-3600
Fax Number	:	408-971-6935

Provider Business Practice Location Address
First Line	:	678 N WILSON WAY
Second Line	:	SUITE G
City	:	STOCKTON
State	:	CA
Zip	:	95205-4272
Country	:	US
Telephone Number	:	209-466-2081
Fax Number	:	209-466-2083

Authorized Official
Title or Position	:	CFO
Name	:	MR. TOM MOTSIFF
Credential	:	MHA,CMA
Telephone Number	:	408-795-3707

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/25/2019

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Directions to “PLANNED PARENTHOOD MAR MONTE, INC ” Practice Location

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