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NPI Code Detail

MEDICARE: JAMAAL R GARY RN

MEDICARE:   JAMAAL R GARY  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0200XPediatric Registered Nurse95363568CA
2163WP0808XPsychiatric/Mental Health Registered Nurse95363568CA

General Provider Information

NPI Number : 1073446449
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMAAL R GARY RN
Provider Business Mailing Address
First Line : 2010 MONTEREY CIR APT C
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-7531
Country : US
Telephone Number : 860-970-2798
Fax Number :
Provider Business Practice Location Address
First Line : 2633 E 27TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1912
Country : US
Telephone Number : 510-536-8111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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