Provider Demographics
NPI:1558151431
Name:GARDNER FAMILY HEALTH NETWORK
Entity type:Organization
Organization Name:GARDNER FAMILY HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-938-2113
Mailing Address - Street 1:160 E VIRGINIA ST STE 100
Mailing Address - Street 2:HR/CREDENTIALING DEPT
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-938-2113
Mailing Address - Fax:
Practice Address - Street 1:1783 ALUM ROCK AVE STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1437
Practice Address - Country:US
Practice Address - Phone:408-457-7015
Practice Address - Fax:408-579-6172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDNER FAMILY HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)