| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 750 W 10th St, Gilroy, California |
| Authorized Official Name and Position | Robert Garner (DEPARTMENT DIRECTOR) |
| Authorized Official Contact | 4087925680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
976 Lenzen Ave 3rd Floor San Jose CA 95126-2737 Ph: (408) 792-5680 | 750 W 10th St Gilroy CA 95020-6333 Ph: (408) 847-2424 |
| NPI Number | 1083758080 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083758080 | NPI | - | NPPES |
| 4387 | Other | CA | DRUG MEDI-CAL NUMBER |
| 434387 | Other | CA | STATE PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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