Provider Demographics
NPI:1255399564
Name:CONTRA COSTA MEDICAL GROUP FOR WOMEN, INC.
Entity type:Organization
Organization Name:CONTRA COSTA MEDICAL GROUP FOR WOMEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-724-4435
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1838
Mailing Address - Country:US
Mailing Address - Phone:510-724-4435
Mailing Address - Fax:510-724-4686
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1838
Practice Address - Country:US
Practice Address - Phone:510-724-4435
Practice Address - Fax:510-724-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty