Healthcare Provider Details

I. General information

NPI: 1043246481
Provider Name (Legal Business Name): UNIVERSITY HEALTHCARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100A SAN PABLO TOWN CENTER
SAN PABLO CA
94806
US

IV. Provider business mailing address

7999 GATEWAY BLVD SUITE 200
NEWARK CA
94560-1197
US

V. Phone/Fax

Practice location:
  • Phone: 510-237-2802
  • Fax:
Mailing address:
  • Phone: 510-974-8258
  • Fax: 510-974-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE RUSLEN
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 510-974-8297