Healthcare Provider Details

I. General information

NPI: 1942243308
Provider Name (Legal Business Name): NOEL L CONCEPCION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6466 BAYVIEW DR
OAKLAND CA
94605-3134
US

IV. Provider business mailing address

PO BOX 576649
MODESTO CA
95357-6649
US

V. Phone/Fax

Practice location:
  • Phone: 209-277-6792
  • Fax: 209-844-0334
Mailing address:
  • Phone: 209-573-3333
  • Fax: 209-844-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG56704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberM-1488
License Number StateGU
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG56704
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberM-1488
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: