Healthcare Provider Details

I. General information

NPI: 1063501179
Provider Name (Legal Business Name): PROF. CHRIS J CARON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAGLE RD ALAMEDA HSD
ALAMEDA CA
94501-5100
US

IV. Provider business mailing address

1 EAGLE RD. ALAMEDA HSD
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3582
  • Fax:
Mailing address:
  • Phone: 510-437-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: