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Organization
SAN JOSE CHARTER ACADEMY
Active
Organization
SAN JOSE CHARTER ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY R. COOPER (BUSINESS SERVICE MANAGER)
(626) 856-1693
Entity
Organization
Contact information
Practice address
2021 W ALWOOD ST, WEST COVINA, CA 91790-3259
(626) 856-1693
(626) 480-7118
Mailing address
2021 W ALWOOD ST, WEST COVINA, CA 91790-3259
(626) 856-1693
(626) 480-7118
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SS6023527
MEDI-CAL
CA
Enumeration date
09/02/2012
Last updated
09/02/2012
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