Healthcare Provider Details

I. General information

NPI: 1437178563
Provider Name (Legal Business Name): AMBULATORY CONSULTANTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 TELEGRAPH AVE
OAKLAND CA
94609-2428
US

IV. Provider business mailing address

PO BOX 888398
LOS ANGELES CA
90088-8398
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-2244
  • Fax: 510-547-6637
Mailing address:
  • Phone: 888-991-1101
  • Fax: 903-787-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN W HITE
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 510-295-9260