Healthcare Provider Details

I. General information

NPI: 1568557619
Provider Name (Legal Business Name): GENERATIONS HEALTH CARE FOR WOMEN A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GREEN VALLEY ROAD
FREEDOM CA
95019-3135
US

IV. Provider business mailing address

202 GREEN VALLEY ROAD
FREEDOM CA
95019-3135
US

V. Phone/Fax

Practice location:
  • Phone: 831-722-2473
  • Fax: 831-722-2067
Mailing address:
  • Phone: 831-722-2473
  • Fax: 831-722-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC34605
License Number StateCA

VIII. Authorized Official

Name: DR. DENNIS JAMES CHAMBERLAIN
Title or Position: OWNER
Credential: M.D.
Phone: 831-722-2473