# THE PERMANENTE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407232085
- **Authorized official:** DR. ANA SUKIENNIK-TAKAOKA PH.D. (BEHAVIORAL HEALTH MANAGER II)
- **Authorized official phone:** (510) 752-1075

## Contact information

- **Practice address:** 3900 BROADWAY, OAKLAND, CA 94611-5693
- **Practice address phone:** (510) 752-1075
- **Mailing address:** 275 WEST MACARTHUR BLVD., OAKLAND, CA 94611-5693
- **Mailing address phone:** (510) 752-1075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | PSY 27420 | CA | Yes |

## Other

- **Enumeration date:** 08/05/2015
- **Last updated:** 08/05/2015