Healthcare Provider Details

I. General information

NPI: 1881105005
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 E MONTE VISTA AVE STE 104
VACAVILLE CA
95688-3123
US

IV. Provider business mailing address

2920 TELEGRAPH AVE
BERKELEY CA
94705-2031
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR
Credential:
Phone: 303-601-5392