Provider Demographics
NPI:1881159523
Name:CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-861-9739
Mailing Address - Street 1:19600 VALLCO PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-7136
Mailing Address - Country:US
Mailing Address - Phone:650-338-4776
Mailing Address - Fax:510-280-5620
Practice Address - Street 1:19600 VALLCO PKWY STE 170
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-7136
Practice Address - Country:US
Practice Address - Phone:650-338-4776
Practice Address - Fax:510-280-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center