| |
2015 Virginia St Rm 102 Berkeley CA 94709-2229 | |
(510) 644-6225 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 2015 Virginia St Rm 102, Berkeley, California |
Authorized Official Name and Position | Don Kingdon (INTERIM DIRECTOR) |
Authorized Official Contact | 5105678100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 129 San Leandro CA 94577-0929 Ph: () - | 2015 Virginia St Rm 102 Berkeley CA 94709-2229 Ph: (510) 644-6225 |
NPI Number | 1205362811 |
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Provider Enumeration Date | 05/03/2017 |
Last Update Date | 07/26/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205362811 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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