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Organization
PELLEGRIN BROAD MORSE & MOY MDS & DO
Active
Organization
PELLEGRIN BROAD MORSE & MOY MDS & DO
Active
Other names
Los Gatos Family Physicians Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HANSON (OFFICE/FINANCIAL MANAGER)
(408) 354-4030
Entity
Organization
Contact information
Practice address
143 E MAIN ST, LOS GATOS, CA 95030-6903
(408) 354-3920
(408) 354-0782
Mailing address
143 E MAIN ST, LOS GATOS, CA 95030-6903
(408) 354-3920
(408) 354-0782
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G41377 G67157 G75242
CA
207VX0000X
Obstetrics Physician
G41377 G75242 A55016
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ4068
RR MCR
—
01
—
FNP22360
FICT NAME PERMIT
—
Enumeration date
08/26/2005
Last updated
05/22/2014
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