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SOUTH COUNTY COMMUNITY HEALTH CENTER INC. NPI 1184957771


NPI Information

NPI: 1184957771
Provider Name: SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Doing Business As: RAVENSWOOD FAMILY DENTISTRY

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 05D0955807

Address:
1807 BAY ROAD
EAST PALO ALTO, CA
ZIP 94303
Phone: (650) 330-7407
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SOUTH COUNTY COMMUNITY HEALTH CENTER, INC. is a dental clinic center in East Palo Alto, CA. SOUTH COUNTY COMMUNITY HEALTH CENTER, INC. NPI is 1184957771. The provider is registered as an organization entity type.
The provider Is Doing Business As Ravenswood Family Dentistry.

The provider's business location address is:

1807 BAY ROAD
EAST PALO ALTO, CA
ZIP 94303-312
Phone: (650) 330-7407
Fax: (650) 321-1560

The provider's authorized official is Luisa M. Buada .
The authorized official title is Chief Executive Officer and has the following contact phone number (650) 330-7410.

The CLIA number assigned to this NPI record is 05D0955807 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/14/2009 and was last updated on 8/31/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)APPLIED FORCALIFORNIANo
2261QD0000XClinic/CenterDentalAPPLIED FORCALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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