NPIMap

Organization Active NPI

East Valley Community Clinic, Inc.

  • Community Health Clinic/Center
  • San Jose, CA
National Provider Identifier
1700830296
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
070000036 Issued in CA
Legal business name
EAST VALLEY COMMUNITY CLINIC, INC.
Practice address
2470 Alvin Ave
Suite 60
San Jose, CA 95121-1664
Phone
(408) 274-7100
Fax
(408) 274-8763
NPI assigned
May 20, 2006
Organization subpart
Yes
Parent organization
PLANNED PARENTHOOD MAR MONTE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Authorized official

Name
Rayroz Dodson-Crawford
Title
Cfo
Phone
(408) 795-3607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 070000036 CA Primary

Addresses

Primary practice location

2470 Alvin Ave
Suite 60
San Jose, CA 95121-1664

Mailing address

1691 The Alameda
San Jose, CA 95126-2203
Phone (408) 795-3600

Other identifiers 3

IdentifierTypeStateIssuer
ZZR11665FMedicaidCA
HAP11665FMedicaidCA
BCP11665FMedicaidCA

Other names 1

  • Mar Monte Community Clinic Doing business as

National Provider Directory

National Provider Directory
Part of
Planned Parenthood Mar Monte Inc

Practitioners & affiliated clinicians

Practitioners 9

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": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1700830296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1691 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951262203",
            "telephone_number": "408-795-3600",
            "fax_number": "408-287-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 ALVIN AVE",
            "address_2": "SUITE 60",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951211664",
            "telephone_number": "408-274-7100",
            "fax_number": "408-274-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY COMMUNITY CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLANNED PARENTHOOD MAR MONTE, INC.",
        "enumeration_date": "2006-05-20",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "DODSON-CRAWFORD",
        "authorized_official_first_name": "RAYROZ",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "408-795-3607"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "070000036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR11665F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP11665F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP11665F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mar Monte Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 25, 2014; 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.