Graduated: 1997
NPI: 1639257264
Practice Locations (2)
COUNTY OF SANTA CLARA
750 S BASCOM AVE
SAN JOSE, CA 951282603
4088855000
COUNTY OF SANTA CLARA
750 S BASCOM AVE, VLY HLTH CEN BASCOM
SAN JOSE, CA 951282603
4088855000
Source: CMS National Downloadable File, September 2026.