MEDICARE: EAST BAY REGIONAL PARK DISTRICT

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1912858119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY REGIONAL PARK DISTRICT

Provider Business Mailing Address
First Line	:	17930 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-1950
Country	:	US
Telephone Number	:	510-881-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	17930 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-1950
Country	:	US
Telephone Number	:	510-881-1833
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	RAY IVERSON
Credential	:
Telephone Number	:	510-690-6601

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “EAST BAY REGIONAL PARK DISTRICT ” Practice Location

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