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NPI Code Detail

MEDICARE: SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT

MEDICARE: SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT
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
1261QS1000XStudent Health Clinic/CenterEXE70004FCA

Other Identifiers

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

General Provider Information

NPI Number : 1497975882
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT
Provider Business Mailing Address
First Line : 3095 YERBA BUENA RD
Second Line :
City : SAN JOSE
State : CA
Zip : 95135-1513
Country : US
Telephone Number : 408-270-6480
Fax Number : 408-532-1831
Provider Business Practice Location Address
First Line : 3095 YERBA BUENA RD
Second Line :
City : SAN JOSE
State : CA
Zip : 95135-1513
Country : US
Telephone Number : 408-270-6480
Fax Number : 408-532-1831
Authorized Official
Title or Position : DIRECTOR OF STUDENT HEALTH SERVICES
Name : JANICE ASSADI
Credential : RN
Telephone Number : 408-274-7900
Provider Enumeration Date : 04/26/2007
Last Update Date : 12/18/2014

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Directions to “SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT ” Practice Location

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