NPIMap

Organization Active NPI

Gardner Family Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Alviso, CA
National Provider Identifier
1083654545
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FHC70262F Issued in CA
Legal business name
GARDNER FAMILY HEALTH NETWORK INC
Doing business as
Gardner Family Health Network Inc
Practice address
1621 Gold Street
Alviso, CA 95002-1240
Phone
(408) 935-3933
Fax
(408) 935-3988
NPI assigned
Jun 6, 2006
Last updated
Oct 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ofelia Ruiz
Title
Director
Phone
(408) 935-3971

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 070000152 CA
Community Health Clinic/Center 261QC1500X 070000045 CA
Community Health Clinic/Center 261QC1500X 070000179 CA
Community Health Clinic/Center 261QC1500X 070000007 CA
Community Health Clinic/Center 261QC1500X 070000481 CA
Federally Qualified Health Center (FQHC) 261QF0400X FHC70262F CA Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

1621 Gold Street
Alviso, CA 95002-1240

Mailing address

PO Box 1240
1621 Gold Street
Alviso, CA 95002-1240
Phone (408) 935-3933

Other practice location 1

160 E Virginia St Ste 100
San Jose, CA 95112-5865
Phone (408) 918-2600

Other identifiers 7

IdentifierTypeStateIssuer
FHC11001FMedicaidCA
751005MedicaidCA
FHC70014FMedicaidCA
FHC70872FMedicaidCA
FHC11531FMedicaidCA
FHC70262FMedicaidCA
051150MedicaidCA

Other names 1

  • GARDNER FAMILY HEALTH NETWORK INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111229000245 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890859375 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA
O20191217001965 CA Part B Supplier - Clinic/Group Practice 5890859375 Receives reassigned benefits from 37 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alviso, CA; San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083654545. Details of each certification follow.

Federally qualified health center certification: CCN 551859

Legal name
GARDNER FAMILY HEALTH NETWORK INC
Doing business as
GARDNER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1998
Last certification
Jul 1, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1974 in CA
Enrollment address
195E Virginia St
San Jose, CA 95112-5844

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

725 E Santa Clara St
San Jose, CA 95112
Phone (408) 278-2537

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rafael Vaquerano Individual Corporate OfficerCeo Jan 12, 2024
Adolfo Gomez Porras Individual Corporate DirectorBoard Member Jan 1, 2015
Guillermo Viveros Individual Corporate DirectorBoard Member Jan 1, 2017
William Roth Individual Corporate DirectorBoard Member Mar 1, 2015
Noe Pablo Lozano Individual Corporate DirectorBoard Member Jul 1, 1997
Efrain Coria Individual Corporate OfficerCoo Jul 1, 1997
W-2 Managing Employee Jul 1, 1997
Frank V Serrano Individual Corporate DirectorBoard Member Jun 15, 2004
Patricia Gutierrez Individual Corporate DirectorBoard Memeber Jan 1, 2015

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 41

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1083654545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1240",
            "address_2": "1621 GOLD STREET",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950021240",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 GOLD STREET",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950021240",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Virginia St Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951125865",
            "country_code": "US",
            "telephone_number": "408-918-2600",
            "fax_number": "408-579-6143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "OFELIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "408-935-3971"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000152",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000045",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000179",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000007",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000481",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "FHC70262F",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11001F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "751005",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70014F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70872F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11531F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70262F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alviso, CA

Sources for this page

Verify at the official NPI Registry.