MEDICARE: DEPARTMENT OF HEALTH SERVICES

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
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255386603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF HEALTH SERVICES

Provider Business Mailing Address
First Line	:	850 MARINA BAY PKWY
Second Line	:	VRDL
City	:	RICHMOND
State	:	CA
Zip	:	94804-6403
Country	:	US
Telephone Number	:	510-307-8575
Fax Number	:	510-307-8601

Provider Business Practice Location Address
First Line	:	850 MARINA BAY PKWY
Second Line	:	VRDL
City	:	RICHMOND
State	:	CA
Zip	:	94804-6403
Country	:	US
Telephone Number	:	510-307-8575
Fax Number	:	510-307-8601

Authorized Official
Title or Position	:	RESEARCH SCIENTIST SECTION CHIEF
Name	:	HAYNES W SHEPPARD
Credential	:	PHD
Telephone Number	:	510-307-8538

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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Directions to “DEPARTMENT OF HEALTH SERVICES ” Practice Location

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