Healthcare Provider Details

I. General information

NPI: 1114083482
Provider Name (Legal Business Name): ALAMEDA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 FAIRMONT DR
SAN LEANDRO CA
94578-1001
US

IV. Provider business mailing address

2060 FAIRMONT DR
SAN LEANDRO CA
94578-1001
US

V. Phone/Fax

Practice location:
  • Phone: 510-346-1454
  • Fax: 510-614-9516
Mailing address:
  • Phone: 510-346-1454
  • Fax: 510-614-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHPE37659
License Number StateCA

VIII. Authorized Official

Name: MARTHA YASAVOLIAN
Title or Position: DIR OF PHCY
Credential:
Phone: 510-437-5055