Provider Demographics
NPI:1790031995
Name:CCWF
Entity Type:Organization
Organization Name:CCWF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM D
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ZORDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-665-5531
Mailing Address - Street 1:3688 BOYER CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4904
Mailing Address - Country:US
Mailing Address - Phone:510-910-7244
Mailing Address - Fax:
Practice Address - Street 1:3688 BOYER CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4904
Practice Address - Country:US
Practice Address - Phone:510-910-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH23059251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization