Healthcare Provider Details

I. General information

NPI: 1972243574
Provider Name (Legal Business Name): CARBON HEALTH EAST BAY MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5829 LONE TREE WAY # D110
ANTIOCH CA
94531-8603
US

IV. Provider business mailing address

300 CALIFORNIA ST FL 7
SAN FRANCISCO CA
94104-1415
US

V. Phone/Fax

Practice location:
  • Phone: 925-204-3715
  • Fax: 888-972-1912
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITLIN BOYLE
Title or Position: DIRECTOR
Credential:
Phone: 303-601-5392