=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306934252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF FREMONT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 04/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 CAPITOL AVE BLDG B
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-574-2050
-----------------------------------------------------
Fax | 510-574-2054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 CAPITOL AVE BLDG B
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-574-2050
-----------------------------------------------------
Fax | 510-574-2054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY DIRECTOR
-----------------------------------------------------
Name | ARQUIMIDES CALDERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-574-2056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------