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Organization
SAN JOSE MEDICAL CLINIC, INC.
Active
Organization
SAN JOSE MEDICAL CLINIC, INC.
Active
Other names
San Jose Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERNIE ANGEL WALLERSTEIN (C.E.O.)
(408) 278-3000
Entity
Organization
Contact information
Practice address
625 LINCOLN AVE, SAN JOSE, CA 95126-3705
(408) 278-3000
Mailing address
400 RACE ST, SAN JOSE, CA 95126-3518
(408) 278-3121
(408) 278-3194
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY20328Y
—
CA
Enumeration date
10/27/2006
Last updated
10/10/2007
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