Provider Demographics
NPI:1942375878
Name:SANTA CLARA COUNTY CCS
Entity Type:Organization
Organization Name:SANTA CLARA COUNTY CCS
Other - Org Name:JUANA BRIONES MTU
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-793-6200
Mailing Address - Street 1:720 EMPEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4710
Mailing Address - Country:US
Mailing Address - Phone:408-793-6200
Mailing Address - Fax:408-793-6250
Practice Address - Street 1:638 MAYBELL AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3815
Practice Address - Country:US
Practice Address - Phone:650-845-3000
Practice Address - Fax:650-856-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00036FMedicaid