1629604657 NPI number — SOUTH BAY MEDICAL CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629604657 NPI number — SOUTH BAY MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH BAY MEDICAL CENTER, 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:
1629604657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16400 LARK AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-515-4699
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16421 GREENWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTE SERENO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95030-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-384-9717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MOAYED
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
408-515-4699

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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