1154302123 NPI number — CONTRA COSTA COMMUNITY COLLEGE DISTRICT

Table of content: (NPI 1154302123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154302123 NPI number — CONTRA COSTA COMMUNITY COLLEGE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTRA COSTA COMMUNITY COLLEGE DISTRICT
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:
6
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:
1154302123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 GOLF CLUB RD
Provider Second Line Business Mailing Address:
LHS 102
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-685-1230
Provider Business Mailing Address Fax Number:
925-689-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 GOLF CLUB RD
Provider Second Line Business Practice Location Address:
LHS 102
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-685-1230
Provider Business Practice Location Address Fax Number:
925-689-6529
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
SUPERVISING DENTIST
Authorized Official Telephone Number:
925-685-1230

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G9080301 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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