1053364109 NPI number — PLANNED PARENTHOOD MAR MONTE, INC

Table of content: (NPI 1053364109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053364109 NPI number — PLANNED PARENTHOOD MAR MONTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANNED PARENTHOOD MAR MONTE, INC
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:
Provider Other Organization Name Type Code:
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:
1053364109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 THE ALAMEDA
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:
95126-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-795-3600
Provider Business Mailing Address Fax Number:
408-971-6935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 RENZ LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILROY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95020-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-847-1739
Provider Business Practice Location Address Fax Number:
408-847-5146
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSTIFF
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
408-795-3707

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  070000170 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CMM70243F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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