Provider Demographics
NPI:1124701800
Name:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Entity type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-601-5392
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:415-446-1733
Mailing Address - Fax:
Practice Address - Street 1:109 S LAS POSAS RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2419
Practice Address - Country:US
Practice Address - Phone:760-258-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty