Healthcare Provider Details

I. General information

NPI: 1699596288
Provider Name (Legal Business Name): PATHWAYS TO SERVICES DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 BAY ST APT 203
FREMONT CA
94538-4237
US

IV. Provider business mailing address

4165 BAY ST APT 203
FREMONT CA
94538-4237
US

V. Phone/Fax

Practice location:
  • Phone: 510-860-7345
  • Fax:
Mailing address:
  • Phone: 510-860-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JAMES JOSEPH GONZALES
Title or Position: CEO
Credential:
Phone: 510-860-7345