Healthcare Provider Details

I. General information

NPI: 1689710659
Provider Name (Legal Business Name): MR. ANDREW MALCOLM MCLEOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 ALABAMA ST TELECARE SOLANO STRIDES
VALLEJO CA
94590-4511
US

IV. Provider business mailing address

1027 ALABAMA ST TELECARE SOLANO STRIDES
VALLEJO CA
94590-4511
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-1600
  • Fax: 707-558-1606
Mailing address:
  • Phone: 707-558-1600
  • Fax: 707-558-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: