Healthcare Provider Details

I. General information

NPI: 1265971949
Provider Name (Legal Business Name): CALIFORNIA POST-ACUTE MEDICAL GROUP 1, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 WESTLINE DR
ALAMEDA CA
94501-5847
US

IV. Provider business mailing address

5000 HOPYARD RD SUITE 100
PLEASANTON CA
94588-3348
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-0684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SUJAL MANDAVIA
Title or Position: PRESIDENT
Credential: M.D
Phone: 865-693-1000