Healthcare Provider Details

I. General information

NPI: 1225114291
Provider Name (Legal Business Name): CHILDREN FIRST MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 ALCATRAZ AVE
BERKELEY CA
94703-2714
US

IV. Provider business mailing address

1833 ALCATRAZ AVE
BERKELEY CA
94703
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3443
  • Fax: 510-450-5892
Mailing address:
  • Phone: 510-428-3443
  • Fax: 510-450-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD A KUTNIK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 510-428-3472