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EVERGREEN PEDIATRIC ASSOCIATES INC. NPI 1215960455


NPI Information

NPI: 1215960455
Provider Name: EVERGREEN PEDIATRIC ASSOCIATES INC.
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D1059696

Address:
1642 E CAPITOL EXPY
SAN JOSE, CA
ZIP 95121
Phone: (408) 270-3374
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EVERGREEN PEDIATRIC ASSOCIATES INC. is a pediatrics in San Jose, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. EVERGREEN PEDIATRIC ASSOCIATES INC. NPI is 1215960455. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1642 E CAPITOL EXPY
SAN JOSE, CA
ZIP 95121-800
Phone: (408) 270-3374
Fax: (408) 270-3384

The provider's authorized official is Linda M. Ha .
The authorized official title is Secretary and has the following contact phone number (408) 270-3374.

The CLIA number assigned to this NPI record is 05D1059696 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsFNP32950CALIFORNIAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0102160MEDICAIDCALIFORNIA

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: 4/28/2024

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