Full Name | |
---|---|
Speciality | Clinic/center - Public Health, State Or Local |
Location | 384 14th St, Oakland, California |
Authorized Official Name and Position | David W. Modersbach (DIRECTOR) |
Authorized Official Contact | 5105321930 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1900 Fruitvale Ave Ste 3e Oakland CA 94601-2469 Ph: (510) 532-1930 | 384 14th St Oakland CA 94612-3211 Ph: (510) 532-1930 |
NPI Number | 1407109986 |
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Provider Enumeration Date | 10/20/2012 |
Last Update Date | 03/20/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407109986 | NPI | - | NPPES |
1407109986 | Medicaid | CA |
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