Organization
SUTTER EAST BAY MEDICAL FOUNDATION
Active
Organization
SUTTER EAST BAY MEDICAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEN ALISON (CHIEF EXECUTIVE OFFICER)
(925) 962-6613
Entity
Organization
Contact information
Practice address
2850 TELEGRAPH AVENUE, SUITE 130, BERKELEY, CA 94705-1159
(510) 883-9883
(510) 843-0804
Mailing address
PO BOX 255789, SACRAMENTO, CA 95865-5789
(510) 883-9883
(510) 843-0804
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLP 326046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AY764
MEDICARE PTAN
CA
Enumeration date
08/15/2007
Last updated
03/19/2009
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