# EAST BAY VASCULAR MEDICAL GROUP

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

## Provider details

- **NPI number:** 1861503351
- **Authorized official:** NANCI CARTER WEBB (PRACTICE MANAGER)
- **Authorized official phone:** (510) 832-6131

## Contact information

- **Practice address:** 365 HAWTHORNE AVE, SUITE 103, OAKLAND, CA 94609-3107
- **Practice address phone:** (510) 832-6131
- **Mailing address:** 365 HAWTHORNE AVE, SUITE 103, OAKLAND, CA 94609-3107
- **Mailing address phone:** (510) 832-6131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 01/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZZ82873Z | — | CA |