Provider Demographics
NPI:1497834121
Name:EAST BAY PRIMARY AND PREVENTIVE CARE MEDICAL CORP
Entity Type:Organization
Organization Name:EAST BAY PRIMARY AND PREVENTIVE CARE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINREICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-848-5310
Mailing Address - Street 1:3000 COLBY ST
Mailing Address - Street 2:#307
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2058
Mailing Address - Country:US
Mailing Address - Phone:510-848-5310
Mailing Address - Fax:
Practice Address - Street 1:3000 COLBY ST
Practice Address - Street 2:#307
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2058
Practice Address - Country:US
Practice Address - Phone:510-848-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29593ZMedicare PIN