Healthcare Provider Details

I. General information

NPI: 1881159523
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 VALLCO PKWY STE 170
CUPERTINO CA
95014-7136
US

IV. Provider business mailing address

19600 VALLCO PKWY STE 170
CUPERTINO CA
95014-7136
US

V. Phone/Fax

Practice location:
  • Phone: 650-338-4776
  • Fax: 510-280-5620
Mailing address:
  • Phone: 650-338-4776
  • Fax: 510-280-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
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