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General NPI Number Information
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NPI Number | 1528011764
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Entity Type | Organization
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Legal Business Name | VERICARE OF CALIFORNIA MEDICAL GROUP
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 81 PROFESSIONAL CTR PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2797
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Country | US
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Telephone | 800-257-8715
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Fax | 800-819-1655
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Provider Business Mailing Address
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Address Line | 4715 VIEWRIDGE AVE STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92123-1680
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Country | US
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Telephone | 800-257-8715
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Fax | 800-816-1655
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Authorized Official
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Title or Position | ASSISTANT CORPORATE SECRETARY
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Name | DANIEL R. BUDD
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Credential |
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Telephone | 800-257-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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