MEDICARE: CAL PEP

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174059653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL PEP

Provider Business Mailing Address
First Line	:	2811 ADELINE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-4409
Country	:	US
Telephone Number	:	510-874-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 ADELINE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-4409
Country	:	US
Telephone Number	:	510-874-7850
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GLORIA LOCKETT
Credential	:
Telephone Number	:	510-874-7850

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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Directions to “CAL PEP ” Practice Location

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