Basic Information
| Provider Information | |||||||||
| NPI: | 1548591134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH CAFE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1292 QUANDT CT | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945492624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252165047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1292 QUANDT CT | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945492624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252165047 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZEGAROWSKI | ||||||||
| AuthorizedOfficialFirstName: | BEATA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9252165047 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 2251G0304X | 18096 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.