Healthcare Provider Details

I. General information

NPI: 1225062532
Provider Name (Legal Business Name): WASHINGTON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 MOWRY AVE SUITE 12
FREMONT CA
94538-1603
US

IV. Provider business mailing address

2557 MOWRY AVE SUITE 12
FREMONT CA
94538-1603
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-3722
  • Fax: 510-793-8783
Mailing address:
  • Phone: 510-793-3722
  • Fax: 510-793-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE CARRERA
Title or Position: OFFICE MANAGER
Credential:
Phone: 510-744-6706