Basic Information
| Provider Information | |||||||||
| NPI: | 1811129752 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUTTER EAST BAY HOSPITALS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUTTER DELTA MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742110 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900742110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553981633 | ||||||||
| FaxNumber: | 5106588593 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 LONE TREE WAY | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257797200 | ||||||||
| FaxNumber: | 9257797276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO SHBA | ||||||||
| AuthorizedOfficialTelephone: | 5104507357 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 140000258 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.