Provider Demographics
NPI:1376179309
Name:SOUTH BAY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTH BAY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-515-4699
Mailing Address - Street 1:16400 LARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2563
Mailing Address - Country:US
Mailing Address - Phone:408-515-4699
Mailing Address - Fax:
Practice Address - Street 1:16400 LARK AVE STE 350
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2560
Practice Address - Country:US
Practice Address - Phone:408-384-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility