MEDICARE: OSTEOPOROSIS CENTER OF SAN JOSE

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	261QR0200X	Radiology Clinic/Center	FAC52131	CA
2	2471B0102X	Bone Densitometry Radiologic Technologist	RHC142268	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	660003967	OTHER	CA	RAILROAD MEDICARE
8	110048492	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75001	OTHER	CA	FIRST HEALTH #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ZZZ54863Z	OTHER	CA	BLUE SHIELD#
5	000519	OTHER	CA	PMG #
6	006083	OTHER	CA	SCCIPA OST #
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891915005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTEOPOROSIS CENTER OF SAN JOSE

Provider Business Mailing Address
First Line	:	25 N. 14TH ST. SUITE 890
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112
Country	:	US
Telephone Number	:	408-288-6694
Fax Number	:	408-288-6698

Provider Business Practice Location Address
First Line	:	25 N 14TH ST STE 890
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6216
Country	:	US
Telephone Number	:	408-288-6694
Fax Number	:	408-288-6698

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BRUCE J DREYFUSS
Credential	:	MD
Telephone Number	:	408-288-6694

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/16/2008

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Directions to “OSTEOPOROSIS CENTER OF SAN JOSE ” Practice Location

Language	Start Address	Practice Location

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