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General NPI Number Information
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NPI Number | 1053657569
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Entity Type | Organization
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Legal Business Name | FIRST RESORT
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 400 30TH ST SUITE 401
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City | OAKLAND
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State | CA
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Zip | 94609-3306
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Country | US
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Telephone | 510-891-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 DAVIS ST SUITE 200B
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1260
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Country | US
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Telephone | 510-569-1200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PROGRAMS
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Name | MS. VALERIE JANAY DOYLE
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Credential | M.A.
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Telephone | 510-569-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 220000477
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 220000395
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 140000330
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License Number State | CA
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