Provider Demographics
NPI:1255386603
Name:DEPARTMENT OF HEALTH SERVICES
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH SCIENTIST SECTION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:HAYNES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-307-8538
Mailing Address - Street 1:850 MARINA BAY PKWY
Mailing Address - Street 2:VRDL
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:510-307-8575
Mailing Address - Fax:510-307-8601
Practice Address - Street 1:850 MARINA BAY PKWY
Practice Address - Street 2:VRDL
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:510-307-8575
Practice Address - Fax:510-307-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB43850FMedicaid
CAZZZ03922ZMedicare ID - Type Unspecified