Provider Demographics
NPI:1376735621
Name:CESAR CHAVEZ MTU
Entity Type:Organization
Organization Name:CESAR CHAVEZ MTU
Other - Org Name:ALAMEDA COUNTY CCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-267-3278
Mailing Address - Street 1:2825 INTERNATIONAL BLVD
Mailing Address - Street 2:ROOM C121
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1543
Mailing Address - Country:US
Mailing Address - Phone:510-434-5200
Mailing Address - Fax:510-434-5222
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4099
Practice Address - Country:US
Practice Address - Phone:510-267-3278
Practice Address - Fax:510-268-7110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAMEDA COUNTY CCS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251P0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CCS00134FOtherMEDICAL PROVIDER NUMBER