Healthcare Provider Details

I. General information

NPI: 1851792121
Provider Name (Legal Business Name): CITY OF FREMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43030 NEWPORT DR
FREMONT CA
94538-6113
US

IV. Provider business mailing address

39155 LIBERTY STREET SUITE E500
FREMONT CA
94537-5006
US

V. Phone/Fax

Practice location:
  • Phone: 510-656-1250
  • Fax:
Mailing address:
  • Phone: 510-574-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNIE BAILEY
Title or Position: ADMINISTRATOR
Credential: MS, MPA, LMFT
Phone: 510-574-2100