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General NPI Number Information
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NPI Number | 1366645293
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Entity Type | Organization
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Legal Business Name | WESTCOAST CHILDREN'S CLINIC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 3301 E. 12TH STREET STE 259
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City | OAKLAND
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State | CA
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Zip | 94601-2940
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Country | US
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Telephone | 510-269-9030
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Fax | 510-269-9031
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Provider Business Mailing Address
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Address Line | PO BOX 7026
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City | OAKLAND
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State | CA
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Zip | 94601-0026
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Country | US
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Telephone | 510-269-9030
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Fax | 510-269-9031
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Authorized Official
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Title or Position | DIRECTOR OF QA AND COMPLIANCE
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Name | MRS. AMELIA NEWTON GROSU
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Credential | LCSW
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Telephone | 510-269-9148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 020000193
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License Number State | CA
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