Healthcare Provider Details

I. General information

NPI: 1780173724
Provider Name (Legal Business Name): WELLBOUND OF EMERYVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARK CENTER DR STE 120
SACRAMENTO CA
95825
US

IV. Provider business mailing address

300 SANTANA ROW STE 300
SAN JOSE CA
95128-2424
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-8005
  • Fax: 916-486-9585
Mailing address:
  • Phone: 650-404-3655
  • Fax: 650-625-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE VINCENT
Title or Position: PRESIDENT/COO
Credential:
Phone: 650-404-3600