1376735621 NPI number — CESAR CHAVEZ MTU

Table of content: (NPI 1376735621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376735621 NPI number — CESAR CHAVEZ MTU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CESAR CHAVEZ MTU
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:
ALAMEDA COUNTY CCS
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:
1376735621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2825 INTERNATIONAL BLVD
Provider Second Line Business Mailing Address:
ROOM C121
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-434-5200
Provider Business Mailing Address Fax Number:
510-434-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-4099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-267-3278
Provider Business Practice Location Address Fax Number:
510-268-7110
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF THERAPIST
Authorized Official Telephone Number:
510-267-3278

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , 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: CCS00134F . This is a "MEDICAL PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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