MEDICARE: SANTA CLARA OSTOMY & MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies		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	:	1548268261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CLARA OSTOMY & MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2455 FOREST AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1505
Country	:	US
Telephone Number	:	408-296-7890
Fax Number	:	408-296-5225

Provider Business Practice Location Address
First Line	:	2455 FOREST AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1505
Country	:	US
Telephone Number	:	408-296-7890
Fax Number	:	408-296-5225

Authorized Official
Title or Position	:	MANAGER
Name	:	KATHY RICCARDI I
Credential	:	A.B.C CERTIFICATION
Telephone Number	:	408-296-7890

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/21/2022

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Directions to “SANTA CLARA OSTOMY & MEDICAL SUPPLY ” Practice Location

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