Provider Demographics
NPI:1396792875
Name:SAN JOSE CITY COLLEGE STUDENT HEALTH SERVICES
Entity type:Organization
Organization Name:SAN JOSE CITY COLLEGE STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-288-3821
Mailing Address - Street 1:2100 MOORPARK AVE
Mailing Address - Street 2:SC109
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2723
Mailing Address - Country:US
Mailing Address - Phone:408-288-3724
Mailing Address - Fax:408-297-4865
Practice Address - Street 1:2100 MOORPARK AVE
Practice Address - Street 2:SC109
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2723
Practice Address - Country:US
Practice Address - Phone:408-288-3724
Practice Address - Fax:408-297-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
CA261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70007FMedicaid