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NPI Code Detail

MEDICARE: WESTCOAST CHILDREN'S CLINIC

MEDICARE: WESTCOAST CHILDREN'S CLINIC
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
1251S00000XCommunity/Behavioral Health AgencyCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181931OTHERCAMEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number : 1558424374
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTCOAST CHILDREN'S CLINIC
Provider Business Mailing Address
First Line : 3301 E 12TH ST STE 259
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2940
Country : US
Telephone Number : 510-269-9030
Fax Number : 510-269-9031
Provider Business Practice Location Address
First Line : 3301 E 12TH ST STE 259
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2940
Country : US
Telephone Number : 510-269-9030
Fax Number : 510-269-9031
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : APRIL DESIREE FERNANDO
Credential : PHD
Telephone Number : 510-269-9098
Provider Enumeration Date : 12/19/2006
Last Update Date : 08/07/2007

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1699821348 — NEFERKARE STEWART KHEMRE PHD
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1598801474 — ERIN MICHELLE ROSENBLATT PSYD
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Directions to “WESTCOAST CHILDREN'S CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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