NPIMap

Organization Active NPI

South County Community Health Center, Inc.

  • Dental Clinic/Center
  • East Palo Alto, CA
National Provider Identifier
1184957771
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
APPLIED FOR Issued in CA
Legal business name
SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Practice address
1807 Bay Road
East Palo Alto, CA 94303-1312
Phone
(650) 330-7407
Fax
(650) 321-1560
NPI assigned
Sep 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Authorized official

Name
Ms. Luisa M. Buada, RN, MPH
Title
Chief Executive Officer
Phone
(650) 330-7410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X APPLIED FOR CA Primary
Federally Qualified Health Center (FQHC) 261QF0400X APPLIED FOR CA

Addresses

Primary practice location

1807 Bay Road
East Palo Alto, CA 94303-1312

Mailing address

1885 Bay Rd
East Palo Alto, CA 94303-1312
Phone (650) 330-7410

Other names 1

  • Ravenswood Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southcommunityhealthcenteri5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1807 Bay Rd
East Palo Alto, CA 94303
Phone (650) 289-7700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440979200000",
    "number": "1184957771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 BAY RD",
            "city": "EAST PALO ALTO",
            "state": "CA",
            "postal_code": "943031312",
            "telephone_number": "650-330-7410",
            "fax_number": "650-321-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 BAY ROAD",
            "city": "EAST PALO ALTO",
            "state": "CA",
            "postal_code": "943031312",
            "telephone_number": "650-330-7407",
            "fax_number": "650-321-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2015-08-31",
        "status": "A",
        "authorized_official_last_name": "BUADA",
        "authorized_official_first_name": "LUISA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "650-330-7410",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "APPLIED FOR",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "APPLIED FOR",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ravenswood Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; 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.