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General NPI Number Information
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NPI Number | 1013007889
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Entity Type | Organization
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Legal Business Name | CONTRA COSTA ENT MEDICAL ASSOC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 2700 GRANT ST SUITE 104
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City | CONCORD
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State | CA
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Zip | 94520
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Country | US
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Telephone | 925-685-7400
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Fax | 925-685-0917
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Provider Business Mailing Address
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Address Line | 2700 GRANT STREET SUITE 104
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City | CONCORD
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State | CA
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Zip | 94520
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Country | US
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Telephone | 925-685-7400
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Fax | 925-685-0917
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. RANDALL K WENOKUR
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Credential | MD
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Telephone | 825-685-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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