Provider Demographics
NPI:1609111830
Name:CLAUDELL STEPHENS MD AND YVONNE COBBS NP MEDICAL PRACTICES
Entity Type:Organization
Organization Name:CLAUDELL STEPHENS MD AND YVONNE COBBS NP MEDICAL PRACTICES
Other - Org Name:HEALTHY LIVING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:CARLISA
Authorized Official - Last Name:COBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN, ANP-C
Authorized Official - Phone:510-964-9275
Mailing Address - Street 1:1063 SAN PABLO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2473
Mailing Address - Country:US
Mailing Address - Phone:510-964-9275
Mailing Address - Fax:888-804-1432
Practice Address - Street 1:1063 SAN PABLO AVE STE B
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2473
Practice Address - Country:US
Practice Address - Phone:510-964-9275
Practice Address - Fax:888-804-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34895261QH0100X
CANP11980363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP11980Medicare UPIN
CAG34895Medicare UPIN