Basic Information
| Provider Information | |||||||||
| NPI: | 1932131489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN RAMON REGIONAL MEDICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57436 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900747436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095782513 | ||||||||
| FaxNumber: | 9252750107 | ||||||||
| Practice Location | |||||||||
| Address1: | 6001 NORRIS CANYON RD | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945835400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252759200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHADHA | ||||||||
| AuthorizedOfficialFirstName: | BEENU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9252758433 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 140000345 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 232976870 | 01 | AETNA US HEALTHCARE | OTHER | HSP40689F | 05 | CA | MEDICAID | ZZZA0700Z | 01 | BS OF CALIFORNIA | OTHER | 000411 | 01 | HUMANA | OTHER | 050689B000000 | 01 | SECTION 1011 | OTHER | HSP30689G | 05 | CA | MEDICAID | HSP40689G | 05 | CA | MEDICAID | 005041-0001 | 01 | PACIFICARE OF CALIFORNIA | OTHER |