Provider Demographics
NPI:1740399567
Name:NORTHERN CALIFORNIA PRIMARY CARE
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS & BILLING MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-276-7759
Mailing Address - Street 1:1860 EL CAMINO REAL STE 321
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3114
Mailing Address - Country:US
Mailing Address - Phone:650-692-5760
Mailing Address - Fax:650-692-2436
Practice Address - Street 1:1860 EL CAMINO REAL STE 321
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3114
Practice Address - Country:US
Practice Address - Phone:650-692-5760
Practice Address - Fax:650-692-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082440Medicaid
CAF57730Medicare UPIN
CAZZZ14814ZMedicare PIN
CAGR0082440Medicaid