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NPI Code Detail

MEDICARE: COMPREHENSIVE PSYCHIATRIC SERVICES, A MEDICAL GROUP

MEDICARE: COMPREHENSIVE PSYCHIATRIC SERVICES, A MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
22084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11154484749OTHERCANPI
21972666568OTHERCANPI
31982767588OTHERCANPI
41568523306OTHERCANPI
51003977851OTHERCANPI
61215090808OTHERCANPI
71427270248OTHERCANPI

General Provider Information

NPI Number : 1184785834
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE PSYCHIATRIC SERVICES, A MEDICAL GROUP
Provider Business Mailing Address
First Line : 3100 OAK ROAD
Second Line : SUITE 270
City : WALNUT CREEK
State : CA
Zip : 94597-2078
Country : US
Telephone Number : 925-944-9711
Fax Number : 925-944-9709
Provider Business Practice Location Address
First Line : 3100 OAK ROAD
Second Line : SUITE 270
City : WALNUT CREEK
State : CA
Zip : 94597-2078
Country : US
Telephone Number : 925-944-9711
Fax Number : 925-944-9709
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MRS. LEELA VIRASSAMMY
Credential :
Telephone Number : 925-944-9711
Provider Enumeration Date : 12/13/2006
Last Update Date : 09/27/2023

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1184831661 — MR. CRAIG P RUDNICK MD
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