SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT NPI 1497975882

NPI Information

NPI: 1497975882
Provider Name: SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT

Doing Business As: EVERGREEN VALLEY COLLEGESTUDENT HEALTH SERVICES

Classification: Clinic/Center - 261QS1000X
Entity Type: Organization

Specialization: Student Health

Address:
3095 YERBA BUENA RD
SAN JOSE, CA
ZIP 95135
Phone: (408) 270-6480
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SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT is a student health clinic center in San Jose, CA. SAN JOSE/EVERGREEN COMMUNITY COLLEGE DISTRICT NPI is 1497975882. The provider is registered as an organization entity type.
The provider Is Doing Business As Evergreen Valley Collegestudent Health Services.

The provider's business location address is:

3095 YERBA BUENA RD
SAN JOSE, CA
ZIP 95135-513
Phone: (408) 270-6480
Fax: (408) 532-1831

The provider's authorized official is Janice Assadi .
The authorized official title is Director Of Student Health Services and has the following contact phone number (408) 274-7900.

The CLIA number assigned to this NPI record is 05D1065626 - school/student health service with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/26/2007 and was last updated on 12/18/2014.

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
1	261QS1000X	Clinic/Center	Student Health	EXE70004F	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	EXE70004F	MEDICAID	CALIFORNIA

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

NPI Synchronization or Removal

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