Organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Active
Other names
Indian Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALDON WAYNE SCOTT DM (DIRECTOR OF OPERATIONS)
(408) 445-3400
Entity
Organization
Contact information
Practice address
2030 FOREST AVE STE 110, SAN JOSE, CA 95128-4833
(408) 445-3400
Mailing address
1333 MERIDIAN AVE, SAN JOSE, CA 95125-5212
(408) 445-3400
(408) 448-1727
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
70000482
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1120
MEDICARE PALMETTO
CA
01
—
FHC11833F
STATE PROGRAMS
CA
05
—
FHC11833F
—
CA
01
—
G01133-01
DELTA DENTAL
CA
Enumeration date
04/29/2015
Last updated
03/22/2017
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