Healthcare Provider Details

I. General information

NPI: 1558769224
Provider Name (Legal Business Name): CALIFORNIA HOSPITAL MEDICINE PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE
ALAMEDA CA
94501-4399
US

IV. Provider business mailing address

PO BOX 638682
CINCINNATI OH
45263-8682
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-3700
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUJAL S. MANDAVIA
Title or Position: PRESIDENT
Credential: MD
Phone: 800-424-3672