| |
1980 Allston Way Bldg C Classroom C116, C134. C132. C338 Berkeley CA 94704-1463 | |
(510) 317-1444 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 1980 Allston Way Bldg C, Berkeley, California |
Authorized Official Name and Position | Sandy Hobson (QUALITY ASSURANCE DIRECTOR) |
Authorized Official Contact | 5107255727 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6925 Chabot Rd Oakland CA 94618-1921 Ph: (510) 654-4004 | 1980 Allston Way Bldg C Classroom C116, C134. C132. C338 Berkeley CA 94704-1463 Ph: (510) 317-1444 |
NPI Number | 1942590120 |
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Provider Enumeration Date | 04/09/2011 |
Last Update Date | 01/16/2020 |
Certification Date | 01/16/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942590120 | NPI | - | NPPES |
0015 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (California) | Primary |
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