Healthcare Provider Details

I. General information

NPI: 1124135132
Provider Name (Legal Business Name): SUTTER DELTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509-6200
US

IV. Provider business mailing address

PO BOX 742110
LOS ANGELES CA
90074-2110
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7200
  • Fax: 925-779-7258
Mailing address:
  • Phone: 855-398-1633
  • Fax: 925-779-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN TRENT HUNTER
Title or Position: VP SHARED SERVICES
Credential:
Phone: 916-297-8555