Provider Demographics
NPI:1972011187
Name:STAT MED PC A CALIFORNIA MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STAT MED PC A CALIFORNIA MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-234-4447
Mailing Address - Street 1:901 SUNVALLEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5816
Mailing Address - Country:US
Mailing Address - Phone:925-234-4447
Mailing Address - Fax:925-234-4448
Practice Address - Street 1:4465 FIRST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-4915
Practice Address - Country:US
Practice Address - Phone:925-234-4447
Practice Address - Fax:925-234-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care