N/a

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

246RP1900X Issued in CA

Legal business name

N/A

Practice address

4051 Lone Tree Way Ste C
Antioch, CA 94531-6204

Phone

(925) 757-2900

NPI assigned

Jan 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin Roland Martin

Title

Phlebotomist

Phone

(925) 458-5124

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1194055749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 SAN ANDRES DR",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945657651",
            "telephone_number": "925-458-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4051 LONE TREE WAY STE C",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945316204",
            "telephone_number": "925-757-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "N/A",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-04",
        "last_updated": "2010-01-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "ROLAND",
        "authorized_official_title_or_position": "PHLEBOTOMIST",
        "authorized_official_telephone_number": "925-458-5124",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "246RP1900X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA",
            "identifier": "93015226E48032",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Antioch, CA
• Providers in Antioch, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.