Healthcare Provider Details

I. General information

NPI: 1306244850
Provider Name (Legal Business Name): CHABOT FAMILY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19845 LAKE CHABOT RD STE 205
CASTRO VALLEY CA
94546-4055
US

IV. Provider business mailing address

19845 LAKE CHABOT RD STE 205
CASTRO VALLEY CA
94546-4055
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-6424
  • Fax: 510-582-6462
Mailing address:
  • Phone: 510-582-6424
  • Fax: 510-582-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA110274
License Number StateCA

VIII. Authorized Official

Name: MANISH SHRIVASTAVA
Title or Position: CFO
Credential:
Phone: 510-582-6424