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General NPI Number Information
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NPI Number | 1508088279
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Entity Type | Organization
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Legal Business Name | WASHINGTON FAMILY HEALTH MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 38069 MARTHA AVENUE SIUTE 300
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City | FREMONT
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State | CA
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Zip | 94536
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Country | US
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Telephone | 510-608-4800
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Fax | 510-608-0555
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Provider Business Mailing Address
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Address Line | 38069 MARTHA AVENUE SIUTE 300
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City | FREMONT
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State | CA
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Zip | 94536
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Country | US
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Telephone | 510-608-4800
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Fax | 510-608-0555
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Authorized Official
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Title or Position | PRESEIDENT
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Name | DR. BARBARA HUGHES KOSTICK
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Credential | M.D.
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Telephone | 510-608-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G24535
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License Number State | CA
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