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100 N Wiget Ln Ste 200 Walnut Creek CA 94598-5901 | |
| (773) 632-7244 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 100 N Wiget Ln Ste 200, Walnut Creek, California |
| Authorized Official Name and Position | Eric S Kenley (OWNER) |
| Authorized Official Contact | 7736327244 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 N Wiget Ln Ste 200 Walnut Creek CA 94598-5901 Ph: (773) 632-7244 | 100 N Wiget Ln Ste 200 Walnut Creek CA 94598-5901 Ph: (773) 632-7244 |
| NPI Number | 1396261582 |
|---|---|
| Provider Enumeration Date | 08/18/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396261582 | NPI | - | NPPES |
| 1194847475 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | A100640 (California) | Primary |
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