Provider Demographics
NPI:1265898357
Name:GARDNER FAMILY HEALTH NETWORK
Entity type:Organization
Organization Name:GARDNER FAMILY HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-918-2618
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:408-918-2618
Mailing Address - Fax:
Practice Address - Street 1:7526 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5826
Practice Address - Country:US
Practice Address - Phone:408-848-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63902261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental