Provider Demographics
NPI:1124174297
Name:SAN JOSE PACIFIC NEUROLOGY CNTR PROF COR
Entity type:Organization
Organization Name:SAN JOSE PACIFIC NEUROLOGY CNTR PROF COR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-347-1600
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1586
Mailing Address - Country:US
Mailing Address - Phone:408-347-1600
Mailing Address - Fax:408-347-0600
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1586
Practice Address - Country:US
Practice Address - Phone:408-347-1600
Practice Address - Fax:408-347-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA938542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty