Healthcare Provider Details

I. General information

NPI: 1811021405
Provider Name (Legal Business Name): SUTTER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST STE 205
OAKLAND CA
94609-3425
US

IV. Provider business mailing address

350 30TH ST STE 205
OAKLAND CA
94609-3425
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8425
  • Fax: 510-506-7710
Mailing address:
  • Phone: 510-869-8425
  • Fax: 510-506-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number550000581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number550000581
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number550000581
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number550000581
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0942632 CLP322959
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberDEA #FE0575122
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberBD OF PHARMACY #1822
License Number StateCA

VIII. Authorized Official

Name: ANGELYN THOMAS
Title or Position: ADMINISTRATIVE MEDICAL DIRECTOR
Credential:
Phone: 510-869-8425