Healthcare Provider Details

I. General information

NPI: 1215574462
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 TRAVIS BLVD STE C
FAIRFIELD CA
94533-4654
US

IV. Provider business mailing address

2920 TELEGRAPH AVE
BERKELEY CA
94705-2031
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-7400
  • Fax:
Mailing address:
  • Phone: 510-686-3621
  • Fax: 888-972-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR
Credential:
Phone: 417-861-9739