| Pacific East Medical Group, Inc | |
|
10104 San Pablo Ave El Cerrito CA 94530-3510 | |
| (510) 558-0886 | |
| (510) 558-8504 |
| Full Name | Pacific East Medical Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10104 San Pablo Ave, El Cerrito, California |
| Authorized Official Name and Position | Andrew B Wallach (PRESIDENT) |
| Authorized Official Contact | 5105580886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific East Medical Group, Inc 10104 San Pablo Ave El Cerrito CA 94530-3510 Ph: (510) 558-0886 | Pacific East Medical Group, Inc 10104 San Pablo Ave El Cerrito CA 94530-3510 Ph: (510) 558-0886 |
| NPI Number | 1457301632 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0648206599 |
|---|---|
| Medicare Enrollment ID | O20081226000226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457301632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G41883 (California) | Primary |
| Provider Name | Claudell Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437240850 PECOS PAC ID: 2668659178 Enrollment ID: I20110610000076 |
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