Healthcare Provider Details

I. General information

NPI: 1780939165
Provider Name (Legal Business Name): WESTSIDE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 TURNSTONE CIR
PITTSBURG CA
94565-7532
US

IV. Provider business mailing address

356 TURNSTONE CIR
PITTSBURG CA
94565-7532
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-4501
  • Fax:
Mailing address:
  • Phone: 925-432-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberIMF 65983
License Number StateCA

VIII. Authorized Official

Name: DR. MARY JONES
Title or Position: CEO
Credential:
Phone: 415-431-9000