=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962587071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTRA COSTA COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13601 SAN PABLO AVE
-----------------------------------------------------
City | SAN PABLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94806-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-957-5429
-----------------------------------------------------
Fax | 925-957-5401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 DOUGLAS DR STE 310
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94553-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-957-5429
-----------------------------------------------------
Fax | 925-957-5401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY CFO
-----------------------------------------------------
Name | DAVID D. LEE
-----------------------------------------------------
Credential | MBA, FHFMA
-----------------------------------------------------
Telephone | 925-957-5445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 140000090
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------