| Blossom Ridge Medical Group Inc | |
|
15066 Los Gatos Almaden Rd Los Gatos CA 95032 | |
| (408) 377-9180 | |
| (408) 377-1459 |
| Full Name | Blossom Ridge Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 15066 Los Gatos Almaden Rd, Los Gatos, California |
| Authorized Official Name and Position | Kim Lynn Hayes (MANAGER) |
| Authorized Official Contact | 4083773130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Ridge Medical Group Inc 15066 Los Gatos Almaden Rd Los Gatos CA 95032 Ph: (408) 377-9180 | Blossom Ridge Medical Group Inc 15066 Los Gatos Almaden Rd Los Gatos CA 95032 Ph: (408) 377-9180 |
| NPI Number | 1538186275 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 02/25/2015 |
| Medicare PECOS PAC ID | 0446315659 |
|---|---|
| Medicare Enrollment ID | O20090220000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538186275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary D Defigard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710914791 PECOS PAC ID: 4981769197 Enrollment ID: I20090223000173 |
| Provider Name | James Kirk Zimmer |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1306878772 PECOS PAC ID: 6709941917 Enrollment ID: I20090304000480 |
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