MEDICARE: DR. U-SHAKA CRAIG PH.D.

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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1144411125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. U-SHAKA CRAIG PH.D.

Provider Business Mailing Address
First Line	:	9925 INTERNATIONAL BLVD
Second Line	:	SUITE 6
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:	510-562-3731
Fax Number	:	510-562-3734

Provider Business Practice Location Address
First Line	:	9925 INTERNATIONAL BLVD
Second Line	:	SUITE 6
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:	510-562-3731
Fax Number	:	510-562-3734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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