Provider Demographics
NPI:1871302224
Name:PUENTE, JOSE JR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PUENTE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GEMWOOD LOOP
Mailing Address - Street 2:SAN JOSE CA 95123
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-771-3740
Mailing Address - Fax:
Practice Address - Street 1:90 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN MARTIN
Practice Address - State:CA
Practice Address - Zip Code:95046-9504
Practice Address - Country:US
Practice Address - Phone:408-852-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210961164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse