| N/a | |
|
4051 Lone Tree Way Ste C Antioch CA 94531-6204 | |
| (925) 757-2900 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4051 Lone Tree Way Ste C, Antioch, California |
| Authorized Official Name and Position | Kevin Roland Martin (PHLEBOTOMIST) |
| Authorized Official Contact | 9254585124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 1869 San Andres Dr Pittsburg CA 94565-7651 Ph: (925) 458-5124 | N/a 4051 Lone Tree Way Ste C Antioch CA 94531-6204 Ph: (925) 757-2900 |
| NPI Number | 1194055749 |
|---|---|
| Provider Enumeration Date | 01/04/2010 |
| Last Update Date | 01/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194055749 | NPI | - | NPPES |
| 93015226E48032 | Other | CA | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 246RP1900X (California) | Primary |
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