Healthcare Provider Details

I. General information

NPI: 1336416569
Provider Name (Legal Business Name): JOHN MUIR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EAST ST
CONCORD CA
94520-1906
US

IV. Provider business mailing address

1400 TREAT BLVD
WALNUT CREEK CA
94597-2142
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-8200
  • Fax: 925-674-2009
Mailing address:
  • Phone: 925-939-3000
  • Fax: 925-941-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number140000285
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL THOMAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 925-212-0216