MEDICARE: SOUTH BAY HOUSECALL DOCTOR 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	207Q00000X	Family Medicine Physician	20A8549	CA

General Provider Information

NPI Number	:	1649618737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY HOUSECALL DOCTOR INC

Provider Business Mailing Address
First Line	:	3640 SWEIGERT RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2448
Country	:	US
Telephone Number	:	408-835-9977
Fax Number	:	800-818-0931

Provider Business Practice Location Address
First Line	:	3640 SWEIGERT RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2448
Country	:	US
Telephone Number	:	408-835-9977
Fax Number	:	800-818-0931

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	VINCENT LE
Credential	:	D.O.
Telephone Number	:	408-835-9977

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	02/20/2014

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