Provider Demographics
NPI:1295925550
Name:BIBETT
Entity type:Organization
Organization Name:BIBETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-798-7250
Mailing Address - Street 1:3018 WILLOW PASS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2543
Mailing Address - Country:US
Mailing Address - Phone:925-798-7250
Mailing Address - Fax:925-798-3359
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 176
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-568-2432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIBETT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01AD251S00000X
CA010006DN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01ADOtherDRUG MEDI-CAL