Organization
CCCMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASH JAIN (CEO)
(510) 796-0222
Entity
Organization
Contact information
Practice address
1149 FERNWOOD DR, MILLBRAE, CA 94030-1011
(650) 302-5864
Mailing address
27206 CALAROGA AVE, HAYWARD, CA 94545-4300
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
22677
CA
363LF0000X
Family Nurse Practitioner
22677
CA
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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