MEDICARE: SILVER PUNZALAN II 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	550000428	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55G596	OTHER	CA	CCN

General Provider Information

NPI Number	:	1790949303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER PUNZALAN II INC

Provider Business Mailing Address
First Line	:	2928 SILVER EST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1234
Country	:	US
Telephone Number	:	408-592-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 SILVER EST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1234
Country	:	US
Telephone Number	:	408-592-6183
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FE O PUNZALAN
Credential	:	RNC,PHN,MSN
Telephone Number	:	408-592-6183

Provider Enumeration Date	:	07/12/2008
Last Update Date	:	07/12/2008

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