MEDICARE: GARDNER FAMILY HEALTH NETWORK 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568253847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER FAMILY HEALTH NETWORK INC

Provider Business Mailing Address
First Line	:	160 E VIRGINIA ST SUITE #100
Second Line	:	CREDENTIALING DEPT
City	:	SAN JOSE
State	:	CA
Zip	:	95112
Country	:	US
Telephone Number	:	408-938-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6317
Country	:	US
Telephone Number	:	408-938-2113
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LAURA PEREZ
Credential	:	CREDENTIALING
Telephone Number	:	408-938-2113

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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