Gardner Family Health Network Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Alviso, CA
NPI 1164552931 · NPPES record last updated May 4, 2023
Key facts
- NPI
- 1164552931
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- FHC70262F (CA)
- Legal business name
- GARDNER FAMILY HEALTH NETWORK INC
- Practice address
- 1621 Gold St.
Alviso, CA 95002-1240 - Phone
- (408) 935-3933
- Fax
- (408) 935-3988
- NPI assigned
- Mar 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Christina Cornell
- Title
- Supervisor
- Phone
- (408) 579-6178
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 32
Practitioners 24
-
Kristen Ayala, LCSW
-
Nhu Diem Thi Dang, LCSW
-
Maria Gabriela Espinoza, M.A. LMFT
-
Rolando E. Goubaud-Reyna, LCSW
-
Nicolette Lee Hinkle, MSW, LCSW
-
Michael Viet Huynh, M.D.
-
Nhi Yen Huynh, M.D
-
Michael Merlin Johnson, LMFT
-
Darryl Lucia, MD
-
Jeff Andrew Prendergast, LCSW
-
Paul Tiger, M.D.
-
Mo Yeav, LCSW
-
Candice Joi Hunter, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN 051812
- Legal name
- GARDNER FAMILY HEALTH NETWORK INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- Non-profit – other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 5, 1974 in CA
- Enrollment address
- 1621 Gold St
Alviso, CA 95002-3530
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Hilda Bocanegra |
Corporate Director | Jul 1, 2022 | |
| Allison L Escho |
Corporate Director | Jul 1, 2022 | |
| Adolfo Gomez Porras |
Corporate Director |
Jan 1, 2015 | |
| Guillermo Viveros |
Corporate Officer |
Nov 1, 2025 | |
| W-2 Managing Employee |
Nov 1, 2025 | ||
| William Roth |
Corporate Director |
Mar 1, 2015 | |
| Noe Pablo Lozano |
Corporate Director |
Jul 1, 1997 | |
| Frank V Serrano |
Corporate Director |
Jun 15, 2004 | |
| Patricia Gutierrez |
Corporate Director |
Jan 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140213001174 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 5890859375 | Practice locations: Alviso, CA |
National Provider Directory
- Tax ID family
- St James Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Supports Brokerage Agency | 251X00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | FHC70262F | CA | Yes |
Addresses
Primary practice location
1621 Gold St.
Alviso, CA 95002-1240
Mailing address
1621 Gold St.
PO Box 1240
Alviso, CA 95002
Phone (408) 935-3933
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HAP11001F | Other | CA | SOFPALV |
| BCP11001F | Other | CA | BCEDPALV |
| EAP11001F | Other | CA | EAPCALV |
| FHC11001F | Medicaid | CA |
Other names
- ALVISO HEALTH CENTER
Other providers in Alviso, CA
- American Respiratory Laboratories
- Carisa Marisol Borromeo
- Robin Lee Contino
- Gardner Family Health Network
- Gardner Family Health Network Inc
- Pacific Clinics
- Milagro Ramirez
All providers in Alviso, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.