Provider Demographics
NPI:1902944796
Name:CITY OF BERKELEY PUBLIC HEALTH CLINIC (RSH)
Entity Type:Organization
Organization Name:CITY OF BERKELEY PUBLIC HEALTH CLINIC (RSH)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-926-9129
Mailing Address - Street 1:1980 ALLSTON WAY # H-105
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1463
Mailing Address - Country:US
Mailing Address - Phone:510-898-9120
Mailing Address - Fax:
Practice Address - Street 1:1980 ALLSTON WAY # H-105
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1463
Practice Address - Country:US
Practice Address - Phone:510-898-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BERKELEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11499FMedicaid