Healthcare Provider Details

I. General information

NPI: 1497834121
Provider Name (Legal Business Name): EAST BAY PRIMARY AND PREVENTIVE CARE MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST #307
BERKELEY CA
94705-2058
US

IV. Provider business mailing address

3000 COLBY ST #307
BERKELEY CA
94705-2058
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-5310
  • Fax:
Mailing address:
  • Phone: 510-848-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA066461
License Number StateCA

VIII. Authorized Official

Name: DR. DON WEINREICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-848-5310