Healthcare Provider Details

I. General information

NPI: 1104959089
Provider Name (Legal Business Name): ALAMEDA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD SUITE 200
OAKLAND CA
94605-2409
US

IV. Provider business mailing address

15400 FOOTHILL BLVD
SAN LEANDRO CA
94578-1009
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5704
  • Fax: 510-568-0225
Mailing address:
  • Phone: 510-895-7344
  • Fax: 510-895-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberEXEMPT UNDER 12-35B
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM MIRANDA
Title or Position: CFO
Credential:
Phone: 510-618-2147