Healthcare Provider Details

I. General information

NPI: 1972057990
Provider Name (Legal Business Name): CARBON HEALTH PRIMARY CARE OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 TELEGRAPH AVE STE 100
BERKELEY CA
94705-2031
US

IV. Provider business mailing address

2100 FRANKLIN ST STE 355
OAKLAND CA
94612-3140
US

V. Phone/Fax

Practice location:
  • Phone: 510-686-3621
  • Fax:
Mailing address:
  • Phone: 415-200-2099
  • Fax: 844-649-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR
Credential:
Phone: 417-861-9739