| Carquinez Ms | |
|
1099 Pomona St Crockett CA 94525-1427 | |
| (510) 787-1081 | |
| (510) 787-2359 |
| Full Name | Carquinez Ms |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1099 Pomona St, Crockett, California |
| Authorized Official Name and Position | Donald Bruce Blasky (CHIEF PROGRAM OFFICER) |
| Authorized Official Contact | 4157552311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carquinez Ms 11175 San Pablo Ave El Cerrito CA 94530-2157 Ph: (510) 599-3009 | Carquinez Ms 1099 Pomona St Crockett CA 94525-1427 Ph: (510) 787-1081 |
| NPI Number | 1417410093 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 08/02/2021 |
| Certification Date | 08/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417410093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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