Healthcare Provider Details

I. General information

NPI: 1679586259
Provider Name (Legal Business Name): CONTRA COSTA INDUSTRIAL MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 BUCHANAN RD
ANTIOCH CA
94509-4402
US

IV. Provider business mailing address

120 BROADWAY AVE STE 23
RICHMOND CA
94804
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9194
  • Fax: 925-777-1120
Mailing address:
  • Phone: 510-236-7243
  • Fax: 510-232-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA A THOMAS
Title or Position: ADMINISTRATOR
Credential: P.A.
Phone: 925-777-9194