Provider Demographics
NPI: | 1588721500 |
---|---|
Name: | COUNTY OF SANTA CLARA |
Entity type: | Organization |
Organization Name: | COUNTY OF SANTA CLARA |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | LORENZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 408-885-4010 |
Mailing Address - Street 1: | PO BOX 103331 |
Mailing Address - Street 2: | |
Mailing Address - City: | PASADENA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91189-3331 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 751 S. BASCOM AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95128-2604 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-885-5000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | COUNTY OF SANTA CLARA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-01-02 |
Last Update Date: | 2025-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 070000085 | 208200000X, 2084P0804X, 207N00000X, 207P00000X, 207Q00000X, 207R00000X, 207T00000X, 207V00000X, 207W00000X, 207Y00000X, 207ZP0105X, 208000000X, 208100000X, 207L00000X |
204C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR0076270 | Medicaid | |
CA | C48592 | Other | RR MEDICARE |
CA | GR0076271 | Medicaid | |
CA | ZZZ15859Z | Medicare PIN | |
CA | ZZZ92396Z | Medicare PIN | |
CA | ZZZ92398Z | Medicare PIN | |
CA | ZZZ74729Z | Medicare PIN |