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General NPI Number Information
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NPI Number | 1447588330
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Entity Type | Organization
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Legal Business Name | PREVENTIVE CARE PATHWAYS
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 5709 MARKET ST
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City | OAKLAND
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State | CA
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Zip | 94608-2811
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Country | US
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Telephone | 510-444-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 5709 MARKET ST
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City | OAKLAND
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State | CA
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Zip | 94608-2811
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Country | US
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Telephone | 510-444-9460
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HENRY GEOFFREY WATSON
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Credential | M.D.
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Telephone | 510-444-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | C41403
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License Number State | CA
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