NPIMap

Organization Active NPI

Gardner Family Health Network Inc

Doing business as Gardner Health Center

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1407985534
Registry record updated May 4, 2023
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 Health Center
Practice address
195 E Virginia St
San Jose, CA 95112-5844
Phone
(408) 935-3933
Fax
(408) 935-3988
NPI assigned
Mar 5, 2007
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X FHC70262F CA Primary
Case Manager/Care Coordinator 171M00000X
Supports Brokerage Agency 251X00000X

Addresses

Primary practice location

195 E Virginia St
San Jose, CA 95112-5844

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
BCO11531FOtherCABCEDPGAR
FHC11531FMedicaidCA
EAP11531FOtherCAEAPCGAR
HAP11531FOtherCASOFPGAR

Other names 1

  • GARDNER HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111229000245 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890859375 1 other NPI on this enrollment
Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407985534. 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 with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0607272Gardner Health Center195 E Virginia St, San Jose, CA 95112Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Family Health Fndtn Alv33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

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

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1407985534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1240",
            "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": "195 E VIRGINIA ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125844",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "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": "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCEDPGAR",
            "identifier": "BCO11531F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11531F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPCGAR",
            "identifier": "EAP11531F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFPGAR",
            "identifier": "HAP11531F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARDNER HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GARDNER HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.