Healthcare Provider Details

I. General information

NPI: 1659410140
Provider Name (Legal Business Name): BRIAN MATTHEW SWOPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKSIDE COMMUNITY HEALTH CENTER 2023 VALE ROAD, SUITE 107
SAN PABLO CA
94806-3834
US

IV. Provider business mailing address

BROOKSIDE COMMUNITY HEALTH CENTER 2023 VALE ROAD, SUITE 107
SAN PABLO CA
94806-3834
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-9800
  • Fax: 510-412-9867
Mailing address:
  • Phone: 510-231-9800
  • Fax: 510-412-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG70553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: