Provider Demographics
NPI:1295858579
Name:JORGE V. CONTRERAS, M.D., APC
Entity Type:Organization
Organization Name:JORGE V. CONTRERAS, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:VASQUEZ
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-629-7095
Mailing Address - Street 1:841 BLOSSOM HILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2704
Mailing Address - Country:US
Mailing Address - Phone:408-629-7095
Mailing Address - Fax:408-281-8235
Practice Address - Street 1:841 BLOSSOM HILL RD STE 215
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-629-7095
Practice Address - Fax:408-281-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45510261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ07232ZMedicare PIN