Basic Information
| Provider Information | |||||||||
| NPI: | 1750634986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONTRA COSTA COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 LOVERIDGE RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2311 LOVERIDGE RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2012 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | AMBROSIO | ||||||||
| AuthorizedOfficialFirstName: | AILEEN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 9254312600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.