| |
5709 Market St Oakland CA 94608-2811 | |
(510) 444-9460 | |
Not Available |
Full Name | |
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Speciality | Nurse Practitioner |
Location | 5709 Market St, Oakland, California |
Authorized Official Name and Position | Robert Phillips (CEO) |
Authorized Official Contact | 5106146829 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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700 Adeline St Oakland CA 94607-2608 Ph: (510) 835-9610 | 5709 Market St Oakland CA 94608-2811 Ph: (510) 444-9460 |
NPI Number | 1043331630 |
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Provider Enumeration Date | 04/02/2007 |
Last Update Date | 12/11/2023 |
Medicare PECOS PAC ID | 9537062302 |
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Medicare Enrollment ID | O20200512002357 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043331630 | NPI | - | NPPES |
010171000 | Medicaid | CA | |
1306967021 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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