Provider Demographics
NPI:1073126710
Name:CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Entity Type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-446-1733
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:415-446-1733
Mailing Address - Fax:
Practice Address - Street 1:6255 SHARLANDS AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2882
Practice Address - Country:US
Practice Address - Phone:415-200-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty