Healthcare Provider Details

I. General information

NPI: 1164460226
Provider Name (Legal Business Name): WASHINGTON NEWARK MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35500 DUMBARTON CT
NEWARK CA
94560-1127
US

IV. Provider business mailing address

35500 DUMBARTON CT
NEWARK CA
94560-1127
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-7535
  • Fax: 510-797-0236
Mailing address:
  • Phone: 510-797-7535
  • Fax: 510-797-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE ADAMS
Title or Position: CLINIC MANAGER
Credential:
Phone: 510-797-7535