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3900 Valley Ave Ste B Pleasanton CA 94566 | |
| (925) 484-8457 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3900 Valley Ave Ste B, Pleasanton, California |
| Authorized Official Name and Position | Michael Stanton Ward (SENIOR DIRECTOR OF ADMINISTRATION) |
| Authorized Official Contact | 5102197451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
390 40th St Oakland CA 94609-2633 Ph: (510) 613-0330 | 3900 Valley Ave Ste B Pleasanton CA 94566 Ph: (925) 484-8457 |
| NPI Number | 1790995959 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790995959 | NPI | - | NPPES |
| 81282 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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