Provider Demographics
NPI:1699068403
Name:SAN JOSE MOTHERS' MILK BANK
Entity type:Organization
Organization Name:SAN JOSE MOTHERS' MILK BANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-998-4550
Mailing Address - Street 1:1887 MONTEREY HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6117
Mailing Address - Country:US
Mailing Address - Phone:408-998-4550
Mailing Address - Fax:408-297-9208
Practice Address - Street 1:1887 MONTEREY HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6117
Practice Address - Country:US
Practice Address - Phone:408-998-4550
Practice Address - Fax:408-297-9208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JOSE MOTHERS' MILK BANK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-26
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMB000020Medicaid
CAMMB000020Medicaid