1811021405 NPI number — EAST BAY PERINATAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811021405 NPI number — EAST BAY PERINATAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BAY PERINATAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTA BATES SUMMIT PERINATAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811021405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 30TH ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-3425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-869-8425
Provider Business Mailing Address Fax Number:
510-506-7710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 30TH ST
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-8425
Provider Business Practice Location Address Fax Number:
510-506-7710
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALHAN
Authorized Official First Name:
ROSWITHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-869-8680

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  550000581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QC1500X , with the licence number: 550000581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0050X , with the licence number: 550000581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 550000581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 05D0942632 CLP322959 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: DEA #FE0575122 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: BD OF PHARMACY #1822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D585 . This is a "MEDI-CAL PRESUMPTIVE ELIG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMM71192F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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