Momentum For Health - Fsp Imd
Psychologist in San Jose, CA. Organization (NPI-2).
NPI number1285877308
StatusActive
Last updated in NPPESDec 28, 2022
Details
- NPI
- 1285877308
- Entity type
- Organization (NPI-2)
- Legal business name
- Momentum For Health - Fsp Imd
- Organization subpart
- No
- Enumeration date
- Apr 20, 2009
- Certification date
- Dec 28, 2022
- Last updated
- Dec 28, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | – | – | Yes |
Other names
- Momentum For Mental Health - Fsp Imd (Former Legal Business Name)
Practice location
86 S 14th StSan Jose, CA 95112-2015
Phone 408-938-8500 · Fax 408-295-4231
Mailing address
1922 The AlamedaSan Jose, CA 95126-1457
Phone 408-642-6053 · Fax 408-642-6049
Authorized official
David K. Mineta
Ceo
6692130755
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