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General NPI Number Information
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NPI Number | 1336321413
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Entity Type | Organization
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Legal Business Name | BROOKSIDE COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 2023 VALE RD SUITE 107
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City | SAN PABLO
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State | CA
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Zip | 94806-3834
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Country | US
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Telephone | 510-231-9810
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 VALE RD SUITE 107
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City | SAN PABLO
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State | CA
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Zip | 94806-3834
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Country | US
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Telephone | 510-231-9810
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LUCINDA BRANNON BAZILE
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Credential |
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Telephone | 510-231-9810
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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 |
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License Number State |
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