IMHOTEP ISSAQUENA MEDICAL GROUP, INC. (NPI# 1831261270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831261270 |
| Entity Type | Organization |
| Organization Name | IMHOTEP ISSAQUENA MEDICAL GROUP, INC. |
| Practice Address |
2023 Vale Rd Suite 211 San Pablo CA 94806-3834 |
| Practice Telephone | 5102310955 |
| Practice Fax Number | 5102310482 |
| Mailing Telephone | 5102310955 |
| Mailing Fax Number | 5102310482 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2008-06-27 |
| Authorized Official Name | OTIS EUGENE ROUNDS (PRESIDENT) |
| Authorized Official Telephone | 5102310955 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
G37795 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G37795 | 05 |
| Street Address |
2023 VALE RD SUITE 211 |
| City | SAN PABLO |
| State | CA |
| Zip Code | 94806-3834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447221809 | Lorna A Cogen | Surgery | 2023 Vale Rd, Suite 8, San Pablo, CA 94806-3834 | 2006-02-01 |
| 1346853520 | Angelina Maria Molina | Nurse Practitioner | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2020-08-26 |
| 1629628037 | Maya Fan Protter | Registered Nurse | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2019-09-17 |
| 1609425461 | Jennifer Nicole Espinoza | Nurse Practitioner | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2019-09-04 |
| 1154896215 | Audrey I Schaps | Family Medicine | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2018-10-04 |
| 1518477108 | Wendy Zun-yed Wu | Dentist | 2023 Vale Rd, San Pablo, CA 94806 | 2017-10-09 |
| 1801306667 | Ashley Ro | Nurse Practitioner | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2017-10-06 |
| 1871010793 | Laura Rebeca Mata Lopez | Nurse Practitioner | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2017-08-23 |
| 1992236483 | Rehimat Momoh Mendy | Nurse Practitioner | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2017-03-25 |
| 1366999088 | Christine Marie Salera | Registered Nurse | 2023 Vale Rd, San Pablo, CA 94806-3834 | 2016-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013574375 | Alejandra Valle | Behavior Technician | 2970 Hilltop Mall Rd Suite 104, Richmond, CA 94806 | 2019-05-22 |
| 1629535042 | Kaitlin Sue Oshiro | Specialist/Technologist | 16401 San Pablo Ave. Spc 153, San Pablo, CA 94806 | 2019-02-21 |
| 1114400561 | Alan Gonzalez | Pharmacist | 13691 San Pablo Ave., San Pablo, CA 94806 | 2018-09-12 |
| 1265918783 | Laurel Dunn | Student in an Organized Health Care Education/Training Program | 15501 San Pablo Ave # G317, Richmond, CA 94806 | 2018-07-17 |
| 1720503592 | Monika Tippie | Marriage & Family Therapist | West County Adult Mental Health, 13585 San Pablo Ave, 2nd Floor, San Pablo, CA 94806 | 2017-08-14 |
| 1225553902 | Charles Marco Aquilina | Student in an Organized Health Care Education/Training Program | Y Team, 3260 Blume Dr., Suite 450, Richmond, CA 94806 | 2017-08-03 |
| 1922538545 | Hui-teh Hsu | Pharmacist | 2714 Holly St, San Pablo, CA 94806 | 2017-06-15 |
| 1063942878 | Meng-ju Yang | Student in an Organized Health Care Education/Training Program | 3260 Blume Dr., Suite 450, Richmond, CA 94806 | 2017-06-14 |
| 1346780020 | Mae Mayfield | Social Worker | 3600 Sierra Ridge Drive Apt # 7304, Richmond, CA 94806 | 2017-03-01 |
| 1487000790 | Pasha Jackson | Family Medicine | 2970 Hilltop Mall Rd Ste 304, Richmond, CA 94806 | 2016-05-05 |
| Find all providers in zip 94806 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801060637 | Brookside Community Health Center | Clinic/Center | 2023 Vale Rd, Suite 107, San Pablo, CA 94806-3834 | 2008-04-14 |
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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.