Provider Demographics
NPI:1538823646
Name:CARDEA HEALTH
Entity type:Organization
Organization Name:CARDEA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHETTIAR
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC, PHD
Authorized Official - Phone:510-207-8622
Mailing Address - Street 1:1850 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2265
Mailing Address - Country:US
Mailing Address - Phone:510-207-8622
Mailing Address - Fax:
Practice Address - Street 1:8350 EDES AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1307
Practice Address - Country:US
Practice Address - Phone:510-207-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
901811OtherALAMEDA COUNTY