Provider Demographics
NPI:1437144920
Name:COUNTY OF SANTA CLARA
Entity Type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:VALLEY HEALTH CENTER AT MOORPARK-SPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:F
Authorized Official - Last Name:BANUELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-885-4001
Mailing Address - Street 1:PO BOX 5280
Mailing Address - Street 2:PATIENT BUSINESS SERVICES
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-5280
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:
Practice Address - Street 1:2400 MOORPARK AVE STE 100
Practice Address - Street 2:VALLEY HEALTH CENTER AT MOORPARK SPECIALTY
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2623
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40038FMedicaid
CA050038Medicare PIN
CAHSP40038FMedicaid