Basic Information
Provider Information | |||||||||
NPI: | 1730238007 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SUTTER BAY HOSPITALS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SUTTER WEST BAY HOSPITALS | ||||||||
OtherOrganizationType: | 4 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 742412 | ||||||||
Address2: |   | ||||||||
City: | LOS ANGELES | ||||||||
State: | CA | ||||||||
PostalCode: | 900742412 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8553981633 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3555 CESAR CHAVEZ | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941104403 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4156007180 | ||||||||
FaxNumber: | 4156007776 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/09/2007 | ||||||||
LastUpdateDate: | 04/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GATES | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | B. | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 5104507357 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   | CA | N |   | Hospitals | General Acute Care Hospital |   | 282E00000X | 220000070 | CA | N |   | Hospitals | Long Term Care Hospital |   | 282E00000X |   | CA | N |   | Hospitals | Long Term Care Hospital |   | 282N00000X | 220000070 | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | HSC00055G | 05 | CA |   | MEDICAID | LTC55243G | 05 | CA |   | MEDICAID | HSP40055F | 05 | CA |   | MEDICAID | LTC55243F | 05 | CA |   | MEDICAID | LTC70042F | 05 | CA |   | MEDICAID | HSC000055G | 05 | CA |   | MEDICAID | HSC00055F | 05 | CA |   | MEDICAID | HSP40055G | 05 | CA |   | MEDICAID | ZZR00055F | 05 | CA |   | MEDICAID |