Healthcare Provider Details

I. General information

NPI: 1801994330
Provider Name (Legal Business Name): CONTRA COSTA OBSTETRICS GYNECOLOGY & INFERTILITY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 LA CASA VIA 100
WALNUT CREEK CA
94598-4863
US

IV. Provider business mailing address

240 LA CASA VIA 100
WALNUT CREEK CA
94598-4863
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-2565
  • Fax: 925-930-8568
Mailing address:
  • Phone: 925-932-2565
  • Fax: 925-930-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELWOOD LENWORTH KRONICK
Title or Position: CHAIRMAN
Credential: MD
Phone: 925-932-2565