Provider Demographics
NPI:1528409620
Name:SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC
Entity Type:Organization
Organization Name:SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC
Other - Org Name:FOOTHILL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-729-4290
Mailing Address - Street 1:2680 S WHITE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2074
Mailing Address - Country:US
Mailing Address - Phone:408-729-4290
Mailing Address - Fax:866-931-7822
Practice Address - Street 1:1560 BERGER DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2703
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:866-931-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)