Provider Demographics
NPI:1740369040
Name:COUNTY OF SANTA CLARA
Entity type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-885-4001
Mailing Address - Street 1:PO BOX 742502
Mailing Address - Street 2:SCVHHS PATIENT BUSINESS SERVICES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2502
Mailing Address - Country:US
Mailing Address - Phone:408-885-7200
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:VALLEY SPECIALTY CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CLARA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000085261QA1903X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG5995OtherRR MEDICARE
CAHSP40038FMedicaid
CA050038Medicare Oscar/Certification