Organization
BROOKSIDE COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCINDA BRANNON BAZILE (EXECUTIVE DIRECTOR)
(510) 231-9810
Entity
Organization
Contact information
Practice address
2023 VALE RD, SUITE 107, SAN PABLO, CA 94806-3834
(510) 231-9810
Mailing address
2023 VALE RD, SUITE 107, SAN PABLO, CA 94806-3834
(510) 231-9810
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
STATE IDENT NUMBER
EAPC70699F
CA
Enumeration date
11/30/2007
Last updated
02/06/2012
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