MEDICARE: SOUTH BAY MEDICAL CENTER, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1487288437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	16400 LARK AVE STE 100
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16400 LARK AVE STE 100
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2563
Country	:	US
Telephone Number	:	408-384-9719
Fax Number	:

Authorized Official
Title or Position	:	FACILITY ADMINISTRATOR
Name	:	ALI MOAYED
Credential	:
Telephone Number	:	408-515-4699

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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