Provider Demographics
NPI:1033347224
Name:THE EPISCOPAL DIOCESE OF EL CAMINO REAL
Entity Type:Organization
Organization Name:THE EPISCOPAL DIOCESE OF EL CAMINO REAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-292-3314
Mailing Address - Street 1:778 S ALMADEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2919
Mailing Address - Country:US
Mailing Address - Phone:408-292-3314
Mailing Address - Fax:408-292-0728
Practice Address - Street 1:778 S ALMADEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2919
Practice Address - Country:US
Practice Address - Phone:408-292-3314
Practice Address - Fax:408-292-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center