Healthcare Provider Details

I. General information

NPI: 1154302123
Provider Name (Legal Business Name): CONTRA COSTA COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 GOLF CLUB RD LHS 102
PLEASANT HILL CA
94523-1529
US

IV. Provider business mailing address

321 GOLF CLUB RD LHS 102
PLEASANT HILL CA
94523-1529
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-1230
  • Fax: 925-689-6529
Mailing address:
  • Phone: 925-685-1230
  • Fax: 925-689-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: VICTORIA LYNN DAY
Title or Position: SUPERVISING DENTIST
Credential: DDS
Phone: 925-685-1230