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NPI Code Detail

MEDICARE: CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC

MEDICARE: CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
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
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1326820069
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Provider Business Mailing Address
First Line : 2100 FRANKLIN ST STE 355
Second Line :
City : OAKLAND
State : CA
Zip : 94612-3140
Country : US
Telephone Number : 415-446-1733
Fax Number :
Provider Business Practice Location Address
First Line : 3032 WILSHIRE BLVD STE A
Second Line :
City : SANTA MONICA
State : CA
Zip : 90403-2370
Country : US
Telephone Number : 310-971-9957
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MARLEY PAGE
Credential :
Telephone Number : 417-861-9739
Provider Enumeration Date : 10/17/2023
Last Update Date : 06/24/2025

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