Provider Demographics
NPI:1306804331
Name:LOSGATOS PEDIATRICS
Entity type:Organization
Organization Name:LOSGATOS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEZECNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-866-7830
Mailing Address - Street 1:320 DARDANELLI LN
Mailing Address - Street 2:STE # 16
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1440
Mailing Address - Country:US
Mailing Address - Phone:408-866-7830
Mailing Address - Fax:408-866-8103
Practice Address - Street 1:320 DARDANELLI LN
Practice Address - Street 2:STE # 16
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1440
Practice Address - Country:US
Practice Address - Phone:408-866-7830
Practice Address - Fax:408-866-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty