Healthcare Provider Details

I. General information

NPI: 1770920886
Provider Name (Legal Business Name): ROTACARE RICHMOND FREE MEDICAL CLINIC AT BRIGHTER BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MACDONALD AVE
RICHMOND CA
94804-3006
US

IV. Provider business mailing address

2727 MACDONALD AVE
RICHMOND CA
94804-3006
US

V. Phone/Fax

Practice location:
  • Phone: 510-903-7516
  • Fax: 510-213-6680
Mailing address:
  • Phone: 510-903-7516
  • Fax: 510-213-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberG11694
License Number StateCA

VIII. Authorized Official

Name: DR. PATE THOMSON
Title or Position: MEDICAL CO-DIRECTOR
Credential: M.D.
Phone: 510-903-7516