MEDICARE: SANTA CLARA COUNTY PALS PROGRAM

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750586574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CLARA COUNTY PALS PROGRAM

Provider Business Mailing Address
First Line	:	871 ENBORG CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2645
Country	:	US
Telephone Number	:	408-896-6986
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 W HEDDING ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1706
Country	:	US
Telephone Number	:	408-896-6986
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	MARYANN BARRY
Credential	:
Telephone Number	:	408-885-6708

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1295893501 — ANITHA GADDIPATI MD
Practice Location Address:

150 W HEDDING ST , MAIN JAIL MEDICAL UNIT
SAN JOSE, CA
95110-1706

Practice Phone: 408-808-5200
Practice Fax:

1114143385 — MARISOL FERNANDEZ
Practice Location Address:

150 W HEDDING ST
SAN JOSE, CA
95110-1706

Practice Phone: 408-808-5221
Practice Fax:

1447458310 — DR. SANJAY J AGARWAL M.D.
Practice Location Address:

150 W HEDDING ST
SAN JOSE, CA
95110-1706

Practice Phone: 408-808-5200
Practice Fax:

1164621389 — ADELINA ALVAREZ JOHNSON
Practice Location Address:

150 W HEDDING ST , CUSTODY MENTAL HEALTH
SAN JOSE, CA
95110-1706

Practice Phone: 408-808-5221
Practice Fax:

1255568655 — YA-HUI HSU FNP
Practice Location Address:

150 W HEDDING ST
SAN JOSE, CA
95110-1706

Practice Phone: 408-808-5226
Practice Fax: 408-808-5236

Directions to “SANTA CLARA COUNTY PALS PROGRAM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.