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817 Harrison Street Oakland CA 94607-4422 | |
(510) 986-0430 | |
(510) 986-0572 |
Full Name | |
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Speciality | Clinic/Center |
Location | 817 Harrison Street, Oakland, California |
Authorized Official Name and Position | George Lee (MEDICAL DIRECTOR) |
Authorized Official Contact | 5109866830 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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101 8th St Ste 100 Oakland CA 94607-4707 Ph: (510) 735-3100 | 817 Harrison Street Oakland CA 94607-4422 Ph: (510) 986-0430 |
NPI Number | 1073827242 |
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Provider Enumeration Date | 07/30/2010 |
Last Update Date | 10/02/2018 |
Medicare PECOS PAC ID | 0244271021 |
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Medicare Enrollment ID | O20100927000582 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073827242 | NPI | - | NPPES |
1447391719 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 140000125 (California) | Primary |
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