1871035048 NPI number — CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC

Table of content: (NPI 1871035048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871035048 NPI number — CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
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:
Provider Other Organization Name Type Code:
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:
1871035048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2920 TELEGRAPH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94705-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-686-3621
Provider Business Mailing Address Fax Number:
888-972-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 W EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-695-5008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAPA
Authorized Official First Name:
GIANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGE
Authorized Official Telephone Number:
415-446-1733

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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