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General NPI Number Information
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NPI Number | 1215574462
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Entity Type | Organization
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Legal Business Name | CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1320 TRAVIS BLVD STE C
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City | FAIRFIELD
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State | CA
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Zip | 94533-4654
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Country | US
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Telephone | 707-624-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 2920 TELEGRAPH AVE
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City | BERKELEY
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State | CA
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Zip | 94705-2031
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Country | US
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Telephone | 510-686-3621
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Fax | 888-972-1912
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARLEY PAGE
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Credential |
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Telephone | 417-861-9739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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