Basic Information
| Provider Information | |||||||||
| NPI: | 1023494572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA CLARA VALLEY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 W HEDDING ST | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951101705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088857200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 751 S BASCOM AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088855000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2015 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | BANUELOS | ||||||||
| AuthorizedOfficialFirstName: | ALFONSO | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4088855000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | PA52661 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.