Kavanagh, Colleen Marie

Kavanagh, Colleen Marie is an individual health care provider with primary practice located at 2500 Merced St , San Leandro CA 94577-4201. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Kavanagh, Colleen Marie can be contacted via phone (510) 454-1000.

Contact Information

Primary practice address
2500 Merced St San Leandro CA 94577-4201
Phone: (510) 454-1000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X A73968 California

Profile Details

NPI number 1174608830
LBN Legal business name Kavanagh, Colleen Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2006
Last updated Dec 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174608830 NPPES
California MEDICAID 00A739680

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