Basic Information
| Provider Information | |||||||||
| NPI: | 1043543325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALAMEDA COUNTY MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15400 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103461468 | ||||||||
| FaxNumber: | 5108947286 | ||||||||
| Practice Location | |||||||||
| Address1: | 15400 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103461468 | ||||||||
| FaxNumber: | 5108947286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2009 | ||||||||
| LastUpdateDate: | 09/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | DOTTERY | ||||||||
| AuthorizedOfficialFirstName: | GEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5105357609 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALAMEDA COUNTY MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 05D0940091 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.