1891915005 NPI number — OSTEOPOROSIS CENTER OF SAN JOSE

Table of content: (NPI 1891915005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891915005 NPI number — OSTEOPOROSIS CENTER OF SAN JOSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTEOPOROSIS CENTER OF SAN JOSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRUCE J DREYFUSS MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891915005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 N. 14TH ST. SUITE 890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-288-6694
Provider Business Mailing Address Fax Number:
408-288-6698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 N 14TH ST STE 890
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95112-6216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-288-6694
Provider Business Practice Location Address Fax Number:
408-288-6698
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DREYFUSS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
408-288-6694

Provider Taxonomy Codes

  • Taxonomy code: 2471B0102X , with the licence number:  RHC142268 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0200X , with the licence number: FAC52131 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 75001 . This is a "FIRST HEALTH #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 660003967 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G642970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ54863Z . This is a "BLUE SHIELD#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000519 . This is a "PMG #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 006083 . This is a "SCCIPA OST #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5148629 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110048492 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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