Organization
CHABOT NEPHROLOGY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ARMSTRONG (BILLING ADMINISTRATOR)
(510) 351-1669
Entity
Organization
Contact information
Practice address
13851 E 14TH ST, 206, SAN LEANDRO, CA 94578-2631
(510) 351-9373
(510) 351-0616
Mailing address
101 CALLAN AVE, SUITE 402, SAN LEANDRO, CA 94577-4584
(510) 351-1663
(510) 351-1035
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
271955
BRENDA PATRICK, NP
CA
05
—
GR0045150
—
CA
05
—
GR0045151
—
CA
01
—
ZZZ05207Z
BLUESHIELD
CA
Enumeration date
05/12/2006
Last updated
12/05/2007
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