Basic Information
| Provider Information | |||||||||
| NPI: | 1689620478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6840 VIA DEL ORO | ||||||||
| Address2: | STE# 210 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842280 | ||||||||
| FaxNumber: | 4087540450 | ||||||||
| Practice Location | |||||||||
| Address1: | 7861 MURRAY AVE | ||||||||
| Address2: | |||||||||
| City: | GILROY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950204604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088421017 | ||||||||
| FaxNumber: | 4088424186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | KLEINHEINZ | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4082842288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 070000696 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC71038F | 01 | CA | MEDI-CAL ID | OTHER |