MYLIFE RECOVERY CENTERS, A MEDICAL CORP. (NPI# 1619372380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619372380 |
| Entity Type | Organization |
| Organization Name | MYLIFE RECOVERY CENTERS, A MEDICAL CORP. |
| Practice Address |
108 La Casa Via Suite 106 Walnut Creek CA 94598-3013 |
| Mailing Address |
10061 Riverside Dr #874 Toluca Lake CA 91602-2560 |
| Practice Telephone | 9252016400 |
| Practice Fax Number | 8187365846 |
| Mailing Telephone | 8187365836 |
| Mailing Fax Number | 8187365846 |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2017-01-30 |
| Authorized Official Name | DR. ALBERT LAI (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8187365836 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | MYLIFE RECOVERY CENTERS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Street Address |
108 LA CASA VIA SUITE 106 |
| City | WALNUT CREEK |
| State | CA |
| Zip Code | 94598-3013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356364871 | Dennis Yunming Fong | Family Medicine | 108 La Casa Via, Suite 104, Walnut Creek, CA 94598 | 2006-07-25 |
| 1265971063 | Bay Area Surgical Specialists | Internal Medicine | 108 La Casa Via, Suite 100, Walnut Creek, CA 94598-3013 | 2017-02-14 |
| 1790229771 | Mlrc, Inc. | Clinic/Center | 108 La Casa Via, Walnut Creek, CA 94598-3013 | 2016-12-12 |
| 1629510201 | Kwon & Jabbour Dental Inc | Dentist | 108 La Casa Via, Suite #102, Walnut Creek, CA 94598-3013 | 2016-11-14 |
| 1114370079 | Kwon & Jabbour Dental, Inc. | Clinic/Center | 108 La Casa Via, Suite 102, Walnut Creek, CA 94598-3013 | 2016-07-15 |
| 1093869455 | Unilab Corporation | Clinical Medical Laboratory | 108 La Casa Via, Ste 105, Walnut Creek, CA 94598-3013 | 2007-01-23 |
| 1851445944 | Qualium Corp. | Clinic/Center | 108 La Casa Via, Suite 100, Walnut Creek, CA 94598-3013 | 2007-01-23 |
| 1245336809 | Dennis Y. Fong, Professional Corporation | Family Medicine | 108 La Casa Via, Suite 104, Walnut Creek, CA 94598 | 2006-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639716608 | Tasnim Diaf Moulton | Counselor | 2730 Shadelands Drive, Walnut Creek, CA 94598 | 2019-12-09 |
| 1790255370 | Harmony Grace Davis | Behavior Technician | 2730 Shadelands Drive Bldg 10, Walnut Creek, CA 94598 | 2018-11-27 |
| 1922583772 | Melissa Anne Mcgovern | Behavioral Analyst | 2370 Shadelands Drive, Bldg 10, Walnut Creek, CA 94598 | 2018-09-27 |
| 1184108367 | Brett Heflin Woodrufff | Behavior Technician | 2730 Shandeland Dr. Building 10, Walnut Creek, CA 94598 | 2018-09-24 |
| 1710411640 | Mandy Wei | Pharmacist | 2880 Shadeland Dr, Suite 201, Walnut Creek, CA 94598 | 2017-04-18 |
| 1437683497 | Hayley Miller | Student in an Organized Health Care Education/Training Program | 2204 Lomond Lane, Walnut Creek, CA 94598 | 2017-04-17 |
| 1043601594 | Marlene Perez Riedel | Nurse Practitioner | 450 North Wiget Lane, Walnut Creek, CA 94598 | 2015-02-05 |
| 1922418904 | Dante Michael Sorrentino | Ophthalmology | Kaiser Permanente Park Shadelands Medical Offices, 320 Lennon Lane, Walnut Creek, CA 94598 | 2014-04-30 |
| 1194156505 | Robert Harrison Hubbell | Obstetrics & Gynecology | 838 Stonehaven Dr, Walnut Creek, CA 94598 | 2013-12-11 |
| 1174954192 | Paul Mead | Orthopaedic Surgery | 2405 Shadelands Dr Ste 300, Walnut Creek, CA 94598 | 2013-12-01 |
| Find all providers in zip 94598 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205462389 | Kyon Amiel Hood Md Inc | General Practice | 1850 Tice Valley Boulevard, Walnut Creek, CA 94595-2224 | 2020-03-20 |
| 1245520139 | Rachna Patel | General Practice | 710 S. Broadway, Suite 204, Walnut Creek, CA 94596 | 2011-04-12 |
| 1952456584 | Richard Neil Paltenghi | General Practice | 1824 Camino Verde, #d, Walnut Creek, CA 94597-2266 | 2007-01-24 |
| 1356670434 | Nancy Gorham Floyd | General Practice | 325 N Wiget Ln, #130, Walnut Creek, CA 94598-2435 | 2009-12-18 |
| 1841407665 | John Muir Physician Network | General Practice | 1450 Treat Blvd, Suite 300, Walnut Creek, CA 94597-2168 | 2007-05-17 |
| 1528122330 | Brandon Davalle | General Practice | 1425 S Main St Fl 2, Walnut Creek, CA 94596-5318 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992986 | Lindsay Fry | General Practice | 375 Bonair St Apt 1, La Jolla, CA 92037-5911 | 2020-11-04 |
| 1255939674 | Kiira Health Practice Ca PC | General Practice | 123 S Figueroa St Apt 1202, Los Angeles, CA 90012-5490 | 2020-10-16 |
| 1851999627 | Golden State Medical Center PC | General Practice | 2551 San Ramon Valley Blvd Ste 108, San Ramon, CA 94583-1661 | 2020-10-14 |
| 1598362709 | Afua Takyi | General Practice | 1555 River Park Dr Ste 211, Sacramento, CA 95815-4604 | 2020-10-01 |
| 1316553530 | Kimberly Ann Callaway | General Practice | 4893 Drakewood Ter, San Diego, CA 92130-1406 | 2020-09-22 |
| 1376156109 | Gtl Medical Group Inc | General Practice | 14555 Hamlin St Ste 107, Van Nuys, CA 91411-1617 | 2020-08-31 |
| 1922611896 | Daniel Lynn Johnson | General Practice | 74075 El Paseo Ste B2, Palm Desert, CA 92260-4118 | 2020-08-28 |
| 1235755299 | Hofmeister Medical, PC | General Practice | 31735 Riverside Dr Ste K, Lake Elsinore, CA 92530-7816 | 2020-06-24 |
| 1033733779 | South Bay Regenerative Medical Spa Inc | General Practice | 412 S Pacific Coast Hwy Ste 100, Redondo Beach, CA 90277-3712 | 2020-05-28 |
| 1568085041 | Integrated Advanced Medicine Inc | General Practice | 210 S Grand Ave Ste 408, Glendora, CA 91741-4282 | 2020-05-19 |
| Find all providers with the same taxonomy | ||||
| City | WALNUT CREEK |
| Zip Code | 94598 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.