MEDICARE: CARBON HEALTH SOUTH BAY PRIMARY CARE PC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1831809672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARBON HEALTH SOUTH BAY PRIMARY CARE PC

Provider Business Mailing Address
First Line	:	2100 FRANKLIN ST STE 355
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-3140
Country	:	US
Telephone Number	:	844-234-7741
Fax Number	:	888-972-1912

Provider Business Practice Location Address
First Line	:	377 SANTANA ROW STE 1180
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2061
Country	:	US
Telephone Number	:	669-247-4773
Fax Number	:	888-972-1912

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KAITLIN BOYLE
Credential	:
Telephone Number	:	303-601-5392

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	07/16/2024

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