Organization
BUCKELEW PROGRAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CHELA L. FIELDING (HOUSE MANAGER)
(510) 653-4180
Entity
Organization
Contact information
Practice address
914 MISSION AVE, 3RD FLOOR, SAN RAFAEL, CA 94901-6106
(415) 457-6964
Mailing address
1044 45TH ST, #B, EMERYVILLE, CA 94608-3392
(510) 653-4180
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
07/24/2007
Last updated
07/24/2007
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