| Pacific East Healthcare, Inc | |
| 
					10104 San Pablo Ave El Cerrito CA 94530-3510  | |
| (510) 558-0886 | |
| (510) 558-8504 | 
| Full Name | Pacific East Healthcare, Inc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 10104 San Pablo Ave, El Cerrito, California | 
| Authorized Official Name and Position | Andrew B Wallach (PRESIDENT) | 
| Authorized Official Contact | 5105580886 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Pacific East Healthcare, Inc 10104 San Pablo Ave El Cerrito CA 94530-3510 Ph: (510) 558-0886  | Pacific East Healthcare, Inc 10104 San Pablo Ave El Cerrito CA 94530-3510 Ph: (510) 558-0886  | 
| NPI Number | 1457301632 | 
|---|---|
| Provider Enumeration Date | 05/11/2006 | 
| Last Update Date | 08/22/2020 | 
| Medicare PECOS PAC ID | 0648206599 | 
|---|---|
| Medicare Enrollment ID | O20081226000226 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1457301632 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G41883 (California) | Primary | 
| Provider Name | Claudell Stephens | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1437240850 PECOS PAC ID: 2668659178 Enrollment ID: I20110610000076  | 
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