Healthcare Provider Details

I. General information

NPI: 1538563614
Provider Name (Legal Business Name): SUTTER EAST BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY SUITE 2182
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

PO BOX 619092
ROSEVILLE CA
95661-9092
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6550
  • Fax:
Mailing address:
  • Phone: 916-297-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 52043
License Number StateCA

VIII. Authorized Official

Name: JOHN B. GATES
Title or Position: CFO
Credential:
Phone: 415-244-2322