| Organization Name: | CCCMA |
| NPI Number: | 1174955587 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ASH JAIN (CEO) |
| Mailing Address: | 1149 Fernwood Dr Millbrae |
| State: | CA US |
| Postal Code: | 940301011 |
| Phone Number: | 6503025864 |
| Fax Number: | |
| NPI Enumeration Date: | 08/07/2013 |
| NPI Last Update Date: | 08/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 22677 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |