MEDICARE: COUNTY OF SANTA CLARA

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1366779399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SANTA CLARA

Provider Business Mailing Address
First Line	:	PO BOX 103331
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91189-3331
Country	:	US
Telephone Number	:	669-299-8165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 LITTLE ORCHARD ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-1031
Country	:	US
Telephone Number	:	408-885-5000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PAUL E LORENZ
Credential	:
Telephone Number	:	408-885-4010

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	12/10/2024

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Directions to “COUNTY OF SANTA CLARA ” Practice Location

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