| Imhotep Issaquena Medical Group | |
|
401 29th St #206 Oakland CA 94609-3519 | |
| (510) 231-0955 | |
| (510) 231-0482 |
| Full Name | Imhotep Issaquena Medical Group |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 401 29th St, Oakland, California |
| Authorized Official Name and Position | Otis Eugene Rounds (PRESIDENT) |
| Authorized Official Contact | 5102310955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imhotep Issaquena Medical Group 2023 Vale Rd #211 San Pablo CA 94806-3834 Ph: (510) 231-0955 | Imhotep Issaquena Medical Group 401 29th St #206 Oakland CA 94609-3519 Ph: (510) 231-0955 |
| NPI Number | 1659405165 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 06/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659405165 | NPI | - | NPPES |
| 00G37795 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G33795 (California) | Primary |
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