Provider Demographics
NPI:1417277617
Name:REDWOOD MEDICAL CENTER
Entity Type:Organization
Organization Name:REDWOOD MEDICAL CENTER
Other - Org Name:PLEASANTON URGENT CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-462-9300
Mailing Address - Street 1:3128 SANTA RITA RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8300
Mailing Address - Country:US
Mailing Address - Phone:925-462-9300
Mailing Address - Fax:925-426-8234
Practice Address - Street 1:3128 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8300
Practice Address - Country:US
Practice Address - Phone:925-462-9300
Practice Address - Fax:925-426-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79953208D00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK158ZMedicare UPIN
CAP72583Medicare UPIN
CAFU643AMedicare UPIN