INDIAN HEALTH CENTER OF SANTA CLARA VALLEY NPI 1629462312

NPI Information

INDIAN HEALTH CENTER OF SANTA CLARA VALLEY is a federally qualified health center (fqhc) clinic center in San Jose, CA. INDIAN HEALTH CENTER OF SANTA CLARA VALLEY NPI is 1629462312. The provider is registered as an organization entity type.
The provider Other Name Is Indian Health Center.

The provider's business location address is:

2039 FOREST AVE STE 105
SAN JOSE, CA
ZIP 95128-815
Phone: (408) 445-3400

The provider's authorized official is Aldon Wayne Scott .
The authorized official title is Director Of Operations and has the following contact phone number (408) 445-3400.

The CLIA number assigned to this NPI record is 05D2042379 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/20/2015 and was last updated on 4/1/2015.

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:

Other Identifiers

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

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