Healthcare Provider Details

I. General information

NPI: 1619971165
Provider Name (Legal Business Name): CALIFORNIA HEART EASTBAY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HIGH SCHOOL AVE STE 312
CONCORD CA
94520-1819
US

IV. Provider business mailing address

2485 HIGH SCHOOL AVE STE 312
CONCORD CA
94520-1819
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-2600
  • Fax: 925-680-0212
Mailing address:
  • Phone: 925-676-2600
  • Fax: 925-680-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELYN M KLISIEWICZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 925-676-2600