Basic Information
| Provider Information | |||||||||
| NPI: | 1932265204 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALAMEDA HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15400 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108957344 | ||||||||
| FaxNumber: | 5108957229 | ||||||||
| Practice Location | |||||||||
| Address1: | 15400 FOOTHILL BLVD BLDG E | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108954200 | ||||||||
| FaxNumber: | 5108954231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | BERNADETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 5106182147 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | HPE40904 | CA | N | Suppliers | Pharmacy | Institutional Pharmacy | 3336L0003X | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | PHB356020 | 05 | CA | MEDICAID | 0562024 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER |