Provider Demographics
NPI:1124347000
Name:EASTER SEALS NORTHERN CALIFORNIA
Entity type:Organization
Organization Name:EASTER SEALS NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ACCOUNTING & HUMAN RESOUR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-382-7450
Mailing Address - Street 1:20 PIMENTEL CT STE A1
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5656
Mailing Address - Country:US
Mailing Address - Phone:415-382-7450
Mailing Address - Fax:415-385-7457
Practice Address - Street 1:20 PIMENTEL CT STE A1
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5656
Practice Address - Country:US
Practice Address - Phone:415-382-7450
Practice Address - Fax:415-385-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty