Provider Demographics
NPI:1770641482
Name:PLANNED PARENTHOOD SHASTA DIABLO INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD SHASTA DIABLO INC
Other - Org Name:PLANNED PARENTHOOD NORTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCESS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-887-5369
Mailing Address - Street 1:2185 PACHECO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2970 HILLTOP MALL RD STE 307
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5274
Practice Address - Country:US
Practice Address - Phone:510-222-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ11925F261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11925FMedicaid
CAZZZ30883ZMedicare ID - Type Unspecified