# BLOSSOM RIDGE MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blossom Ridge Medical Group Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538186275
- **Authorized official:** KIM LYNN HAYES (MANAGER)
- **Authorized official phone:** (408) 377-3130

## Contact information

- **Practice address:** 15066 LOS GATOS ALMADEN RD, LOS GATOS, CA 95032
- **Practice address phone:** (408) 377-9180
- **Practice address fax:** (408) 377-1459
- **Mailing address:** 15066 LOS GATOS ALMADEN RD, LOS GATOS, CA 95032
- **Mailing address phone:** (408) 377-9180
- **Mailing address fax:** (408) 377-1459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 02/25/2015