Provider Demographics
NPI:1447645296
Name:COUNTY OF SANTA CLARA
Entity type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-885-4004
Mailing Address - Street 1:PO BOX 103331
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-3331
Mailing Address - Country:US
Mailing Address - Phone:669-299-8165
Mailing Address - Fax:
Practice Address - Street 1:777 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1934
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:408-885-7307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CLARA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-30
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 261QM1300X
CA070000085261QF0400X, 261QM0850X, 261QP1100X, 261QR0200X, 261QU0200X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751863Medicare Oscar/Certification