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Organization
WESTCOAST CHILDREN'S CLINIC
Active
Organization
WESTCOAST CHILDREN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLEY BRYAN GIN PSYD (DIRECTOR OF CLINICAL SERVICES)
(510) 269-9042
Entity
Organization
Contact information
Practice address
3301 E 12TH ST STE 259, OAKLAND, CA 94601-2940
(510) 269-9030
(510) 269-9031
Mailing address
3301 E 12TH ST STE 259, OAKLAND, CA 94601-2940
(510) 269-9030
(510) 269-9031
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
020000193
CA
Other
Enumeration date
12/30/2008
Last updated
12/09/2011
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