Provider Demographics
NPI:1891915005
Name:OSTEOPOROSIS CENTER OF SAN JOSE
Entity Type:Organization
Organization Name:OSTEOPOROSIS CENTER OF SAN JOSE
Other - Org Name:BRUCE J DREYFUSS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREYFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-288-6694
Mailing Address - Street 1:25 N. 14TH ST. SUITE 890
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-288-6694
Mailing Address - Fax:408-288-6698
Practice Address - Street 1:25 N 14TH ST STE 890
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6216
Practice Address - Country:US
Practice Address - Phone:408-288-6694
Practice Address - Fax:408-288-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHC1422682471B0102X
CAFAC52131261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75001OtherFIRST HEALTH #
CA660003967OtherRAILROAD MEDICARE
CA00G642970Medicaid
CAZZZ54863ZOtherBLUE SHIELD#
CA000519OtherPMG #
CA006083OtherSCCIPA OST #
CA5148629Medicaid
CA110048492OtherRAILROAD MEDICARE
CAZZZ54863ZOtherBLUE SHIELD#
CA75001OtherFIRST HEALTH #