# PELLEGRIN BROAD MORSE & MOY MDS & DO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Los Gatos Family Physicians Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558354373
- **Authorized official:** SUSAN HANSON (OFFICE/FINANCIAL MANAGER)
- **Authorized official phone:** (408) 354-4030

## Contact information

- **Practice address:** 143 E MAIN ST, LOS GATOS, CA 95030-6903
- **Practice address phone:** (408) 354-3920
- **Practice address fax:** (408) 354-0782
- **Mailing address:** 143 E MAIN ST, LOS GATOS, CA 95030-6903
- **Mailing address phone:** (408) 354-3920
- **Mailing address fax:** (408) 354-0782

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | G41377 G67157 G75242 | CA | Yes |
| 207VX0000X | Obstetrics Physician | G41377 G75242 A55016 | CA | — |

## Other

- **Enumeration date:** 08/26/2005
- **Last updated:** 05/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CJ4068 | RR MCR | — |
| 01 | — | FNP22360 | FICT NAME PERMIT | — |