Basic Information
| Provider Information | |||||||||
| NPI: | 1134849045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CALIFORNIA ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941041415 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 46 HILLSDALE MALL | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944033407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507695612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2022 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | GIANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6178941718 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARBON HEALTH PRIMARY CARE OF CALIFORNIA PC | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.