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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
MRS. AMELIA NEWTON GROSU LCSW (DIRECTOR OF QA AND COMPLIANCE)
(510) 269-9148
Entity
Organization
Contact information
Practice address
3301 E. 12TH STREET STE 259, OAKLAND, CA 94601-2940
(510) 269-9030
(510) 269-9031
Mailing address
PO BOX 7026, OAKLAND, CA 94601-0026
(510) 269-9030
(510) 269-9031
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
020000193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01DW
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
06/07/2007
Last updated
12/19/2024
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