MEDICARE: SAMUEL MERRITT COLLEGE

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	213E00000X	Podiatrist	E-4490	CA
2	213E00000X	Podiatrist	E-2309	CA

General Provider Information

NPI Number	:	1427181221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL MERRITT COLLEGE

Provider Business Mailing Address
First Line	:	450 30TH ST
Second Line	:	SUITE 2701
City	:	OAKLAND
State	:	CA
Zip	:	94609-3302
Country	:	US
Telephone Number	:	510-869-1588
Fax Number	:	510-869-1587

Provider Business Practice Location Address
First Line	:	450 30TH ST
Second Line	:	SUITE 2701
City	:	OAKLAND
State	:	CA
Zip	:	94609-3302
Country	:	US
Telephone Number	:	510-869-1588
Fax Number	:	510-869-1587

Authorized Official
Title or Position	:	VP OF FINANCE AND ADMINISTRATION
Name	:	MISS GREGORY GINGRAS
Credential	:	CMA
Telephone Number	:	510-869-1588

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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Directions to “SAMUEL MERRITT COLLEGE ” Practice Location

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