Organization
PATH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LA KEISHIA NICOLE CHILDERS (SR. DIRECTOR OF COMPLIANCE & QA)
(323) 644-2224
Entity
Organization
Contact information
Practice address
290 N 2ND STREET, SAN JOSE, CA 95112-1231
(408) 320-9035
Mailing address
290 N 2ND STREET, SAN JOSE, CA 95112
(408) 320-9035
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
1003223124
CA
Other
Enumeration date
10/26/2016
Last updated
11/19/2019
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