Healthcare Provider Details

I. General information

NPI: 1609111830
Provider Name (Legal Business Name): CLAUDELL STEPHENS MD AND YVONNE COBBS NP MEDICAL PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 SAN PABLO AVE STE B
PINOLE CA
94564-2473
US

IV. Provider business mailing address

1063 SAN PABLO AVE STE B
PINOLE CA
94564-2473
US

V. Phone/Fax

Practice location:
  • Phone: 510-964-9275
  • Fax: 888-804-1432
Mailing address:
  • Phone: 510-964-9275
  • Fax: 888-804-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP11980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP11980
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberG34895
License Number StateCA

VIII. Authorized Official

Name: MS. YVONNE CARLISA COBBS
Title or Position: PARTNER
Credential: RN, PHN, ANP-C
Phone: 510-964-9275