Provider Demographics
NPI:1558754598
Name:SYNERGY HEALTH CENTER & URGENT CARE
Entity Type:Organization
Organization Name:SYNERGY HEALTH CENTER & URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:925-350-4742
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:925-350-4742
Mailing Address - Fax:
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:925-350-4742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOGEN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551003207Q00000X
CAA103633207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty