Provider Demographics
NPI:1942979182
Name:HOSPITAL SAN JOSE SA
Entity Type:Organization
Organization Name:HOSPITAL SAN JOSE SA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-731-1767
Mailing Address - Street 1:2600 DALLAS PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-731-1767
Mailing Address - Fax:
Practice Address - Street 1:600 METROS AL ESTE DEL CENTRO COMERCIAL MULTIPLAZA
Practice Address - Street 2:AUTOPISTA PROSPERO FERNANDEZ
Practice Address - City:SAN JOSE
Practice Address - State:SAN RAFAEL
Practice Address - Zip Code:10201
Practice Address - Country:CR
Practice Address - Phone:855-782-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy