Provider Demographics
NPI:1922366186
Name:GARDNER FAMILY HEALTH NETWORK INC
Entity Type:Organization
Organization Name:GARDNER FAMILY HEALTH NETWORK INC
Other - Org Name:GARDNER PACKARD CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-935-3971
Mailing Address - Street 1:1621 GOLD STREET
Mailing Address - Street 2:
Mailing Address - City:ALVISO
Mailing Address - State:CA
Mailing Address - Zip Code:95002-1240
Mailing Address - Country:US
Mailing Address - Phone:408-200-2291
Mailing Address - Fax:408-935-3988
Practice Address - Street 1:3351 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3811
Practice Address - Country:US
Practice Address - Phone:408-200-2291
Practice Address - Fax:408-278-7799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDNER FAMILY HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-25
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center