NPIMap

Organization Active NPI

Santa Clara OB/GYN Medical Group

  • Obstetrics & Gynecology Physician
  • San Jose, CA
National Provider Identifier
1083890990
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A34509 Issued in CA
Legal business name
SANTA CLARA OB/GYN MEDICAL GROUP
Practice address
2030 Forest Ave
Suite 100
San Jose, CA 95128-4833
Phone
(408) 993-1814
Fax
(408) 993-1822
NPI assigned
Jan 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Mario Cordero, MD
Title
Doctor
Phone
(408) 993-1814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X A34509 CA Primary

Addresses

Primary practice location

2030 Forest Ave
Suite 100
San Jose, CA 95128-4833

Mailing address

PO Box 5040
San Jose, CA 95150-5040
Phone (408) 488-9211

Other identifiers 1

IdentifierTypeStateIssuer
GR0030630MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1083890990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5040",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951505040",
            "telephone_number": "408-488-9211",
            "fax_number": "408-448-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 FOREST AVE",
            "address_2": "SUITE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951284833",
            "telephone_number": "408-993-1814",
            "fax_number": "408-993-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CLARA OB/GYN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "408-993-1814",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A34509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.