Provider Demographics
NPI: | 1326312067 |
---|---|
Name: | VERITY MEDICAL FOUNDATION |
Entity Type: | Organization |
Organization Name: | VERITY MEDICAL FOUNDATION |
Other - Org Name: | DCHS MEDICAL FOUNDATION |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | CHIEF MEDICAL OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DEAN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | DIDECH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, |
Authorized Official - Phone: | 408-278-3193 |
Mailing Address - Street 1: | 400 RACE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN JOSE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95126-3518 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 408-278-3000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 625 LINCOLN AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95126-3705 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-278-3000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DAUGHTERS OF CHARITY HEALTH SYSTEM |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2012-02-27 |
Last Update Date: | 2016-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |