Provider Demographics
NPI:1942254644
Name:VERICARE OF CALIFORNIA MEDICAL GROUP
Entity Type:Organization
Organization Name:VERICARE OF CALIFORNIA MEDICAL GROUP
Other - Org Name:VERICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:O
Authorized Official - Last Name:VOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-257-8715
Mailing Address - Street 1:4715 VIEWRIDGE AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1680
Mailing Address - Country:US
Mailing Address - Phone:800-257-8715
Mailing Address - Fax:800-819-1655
Practice Address - Street 1:430 WILLOW ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6130
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2016-02-26
Deactivation Date:2007-04-11
Deactivation Code:
Reactivation Date:2007-08-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP5000150Medicaid
CACC7816OtherRAILROAD MEDICARE
CAGP5000150Medicaid