Provider Demographics
NPI:1922068402
Name:LOS OLIVOS WOMEN'S MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:LOS OLIVOS WOMEN'S MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-358-4845
Mailing Address - Street 1:PO BOX 11855
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4009
Mailing Address - Country:US
Mailing Address - Phone:408-358-4845
Mailing Address - Fax:408-358-1602
Practice Address - Street 1:15151 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2627
Practice Address - Country:US
Practice Address - Phone:408-358-4845
Practice Address - Fax:408-358-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70380ZOtherPTAN
CA00G617520Medicare ID - Type Unspecified