Basic Information
| Provider Information | |||||||||
| NPI: | 1427295849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALAMEDA COUNTY MEDICLA CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 EAST 31ST STREET | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946021018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104374323 | ||||||||
| FaxNumber: | 5104375042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 EAST 31ST STREET | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946021018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104374323 | ||||||||
| FaxNumber: | 5104375042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | EVA LAVERNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COODINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5104374323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ACUTE CARE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | CA | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | ZZZ30206Z | 01 | CA | MEDICARE ID | OTHER |