Healthcare Provider Details

I. General information

NPI: 1093969891
Provider Name (Legal Business Name): CAL-PEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 FRANKLIN ST 302
OAKLAND CA
94612-2819
US

IV. Provider business mailing address

PO BOX 71629
OAKLAND CA
94612-7829
US

V. Phone/Fax

Practice location:
  • Phone: 510-874-7850
  • Fax:
Mailing address:
  • Phone: 510-874-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORIA LOCKETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-874-7850