MEDICARE: RAMON DEANDRE HALL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1588219877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON DEANDRE HALL

Provider Business Mailing Address
First Line	:	3351 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3005
Country	:	US
Telephone Number	:	510-432-4157
Fax Number	:

Provider Business Practice Location Address
First Line	:	8425 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-3553
Country	:	US
Telephone Number	:	510-432-4157
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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Directions to “ RAMON DEANDRE HALL ” Practice Location

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