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143 E Main St Los Gatos CA 95030-6903 | |
| (408) 354-3920 | |
| (408) 354-0782 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 143 E Main St, Los Gatos, California |
| Authorized Official Name and Position | Susan Hanson (OFFICE/FINANCIAL MANAGER) |
| Authorized Official Contact | 4083544030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
143 E Main St Los Gatos CA 95030-6903 Ph: (408) 354-3920 | 143 E Main St Los Gatos CA 95030-6903 Ph: (408) 354-3920 |
| NPI Number | 1558354373 |
|---|---|
| Provider Enumeration Date | 08/26/2005 |
| Last Update Date | 05/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558354373 | NPI | - | NPPES |
| CJ4068 | Other | RR MCR | |
| FNP22360 | Other | FICT NAME PERMIT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G41377 G67157 G75242 (California) | Primary |
| 207VX0000X | Obstetrics & Gynecology - Obstetrics | G41377 G75242 A55016 (California) | Secondary |
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