Provider Demographics
NPI:1164968178
Name:FREEDOM CHOICE HEALTHCARE INC
Entity Type:Organization
Organization Name:FREEDOM CHOICE HEALTHCARE INC
Other - Org Name:FREEDOM CHOICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-223-8080
Mailing Address - Street 1:2690 S. WHITE RD
Mailing Address - Street 2:#20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2076
Mailing Address - Country:US
Mailing Address - Phone:408-223-8080
Mailing Address - Fax:408-223-8088
Practice Address - Street 1:2690 S WHITE RD
Practice Address - Street 2:SUITE 95
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2076
Practice Address - Country:US
Practice Address - Phone:408-223-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101639261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care