Basic Information
| Provider Information | |||||||||
| NPI: | 1376828947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCI/CST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 S PARK VICTORIA DR APT 315 | ||||||||
| Address2: | |||||||||
| City: | MILPITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950356434 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 MOORPARK AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089752730 | ||||||||
| FaxNumber: | 4089752745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2011 | ||||||||
| LastUpdateDate: | 10/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | HUSIC | ||||||||
| AuthorizedOfficialFirstName: | ARMINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAMM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4089752730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.