Healthcare Provider Details

I. General information

NPI: 1003305236
Provider Name (Legal Business Name): EAST BAY HAND MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 E 14TH ST STE 200
SAN LEANDRO CA
94578-2584
US

IV. Provider business mailing address

13690 E 14TH ST STE 200
SAN LEANDRO CA
94578-2584
US

V. Phone/Fax

Practice location:
  • Phone: 510-297-0550
  • Fax: 510-297-0558
Mailing address:
  • Phone: 510-297-0550
  • Fax: 510-297-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG75352
License Number StateCA

VIII. Authorized Official

Name: BRENDA DENICE COBB
Title or Position: OFFICE SUPERVISOR/BILLING MGR
Credential:
Phone: 510-297-0550