Organization
ALAMEDA HEALTH SYSTEM
Active
Other names
EASTMONT WELLNESS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MIRANDA (CFO)
(510) 618-2147
Entity
Organization
Contact information
Practice address
6955 FOOTHILL BLVD SUITE 200, OAKLAND, CA 94605-2409
(510) 567-5704
(510) 568-0225
Mailing address
15400 FOOTHILL BLVD, SAN LEANDRO, CA 94578-1009
(510) 895-7344
(510) 895-7229
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
EXEMPT UNDER 12-35B
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001116
DD PRIVATE - EASTMONT
CA
01
—
10449
HF ACCESS DNTL - EASTMNT
CA
05
—
BCP11783G
—
CA
05
—
FHC11783G
—
CA
01
—
G01016-03
AA DELTA DENTAL
CA
05
—
HAP11783G
—
CA
Enumeration date
03/13/2007
Last updated
07/05/2023
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