Provider Demographics
NPI:1598082778
Name:CALIFORNIA INFECTION CONTROL CONSULTANTS, INC.
Entity Type:Organization
Organization Name:CALIFORNIA INFECTION CONTROL CONSULTANTS, INC.
Other - Org Name:INTERNATIONAL TRAVELERS' MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-277-2050
Mailing Address - Street 1:5601 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5407
Mailing Address - Country:US
Mailing Address - Phone:925-277-2050
Mailing Address - Fax:925-275-1018
Practice Address - Street 1:5601 NORRIS CANYON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5407
Practice Address - Country:US
Practice Address - Phone:925-277-2050
Practice Address - Fax:925-275-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27536207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43389Medicare UPIN