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General NPI Number Information
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NPI Number | 1710590179
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Entity Type | Organization
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Legal Business Name | CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 220 6TH AVENUE NORTH
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City | SEATTLE
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State | WA
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Zip | 98109
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Country | US
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Telephone | 415-200-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 55 PACIFIC AVE # 101
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-2009
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Country | US
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Telephone | 415-200-2133
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARLEY PAGE
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Credential |
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Telephone | 417-861-9739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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