Provider Demographics
NPI:1427295849
Name:ALAMEDA COUNTY MEDICLA CENTER
Entity type:Organization
Organization Name:ALAMEDA COUNTY MEDICLA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COODINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA LAVERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-437-4323
Mailing Address - Street 1:1411 EAST 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-437-4323
Mailing Address - Fax:510-437-5042
Practice Address - Street 1:1411 EAST 31ST STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4323
Practice Address - Fax:510-437-5042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACUTE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30206ZOtherMEDICARE ID