Provider Demographics
NPI:1538431432
Name:PREVENTIVE CARE PATHWAYS
Entity type:Organization
Organization Name:PREVENTIVE CARE PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-444-9460
Mailing Address - Street 1:5709 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2811
Mailing Address - Country:US
Mailing Address - Phone:510-444-9460
Mailing Address - Fax:510-444-1966
Practice Address - Street 1:5709 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2811
Practice Address - Country:US
Practice Address - Phone:510-444-9460
Practice Address - Fax:510-444-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41403261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center