Healthcare Provider Details

I. General information

NPI: 1699099937
Provider Name (Legal Business Name): JOHN MUIR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3122
US

IV. Provider business mailing address

1400 TREAT BLVD
WALNUT CREEK CA
94597-2142
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-3000
  • Fax: 925-941-2236
Mailing address:
  • Phone: 925-947-3336
  • Fax: 925-941-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0680025
License Number StateCA

VIII. Authorized Official

Name: MR. J KENDALL ANDERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 925-939-3000