Provider Demographics
NPI:1750586020
Name:EMERYVILLE OCCUPATIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:EMERYVILLE OCCUPATIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-365-4565
Mailing Address - Street 1:PO BOX 99440
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94662-9440
Mailing Address - Country:US
Mailing Address - Phone:916-365-4565
Mailing Address - Fax:
Practice Address - Street 1:2356 GOLD MEADOW WAY STE 130
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-6330
Practice Address - Country:US
Practice Address - Phone:916-365-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058556207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC04331Medicare UPIN