MEDICARE: CONTRA COSTA COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP0905X	State or Local Public Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CCS00046F	OTHER	CA	CCS

General Provider Information

NPI Number	:	1093885881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTRA COSTA COUNTY

Provider Business Mailing Address
First Line	:	50 DOUGLAS DR STE 310
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-4003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 DELTA FAIR BLVD
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-3944
Country	:	US
Telephone Number	:	925-427-8522
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY CFO
Name	:	DAVID D. LEE
Credential	:	MBA, FHFMA
Telephone Number	:	925-957-5445

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	10/13/2025

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Directions to “CONTRA COSTA COUNTY ” Practice Location

Language	Start Address	Practice Location

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