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NPI Code Detail

MEDICARE: KAMLA FENNIMORE M.A.

MEDICARE: KAMLA FENNIMORE M.A.
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
11041C0700XClinical Social Worker27514CA

General Provider Information

NPI Number : 1710274519
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMLA FENNIMORE M.A.
Provider Business Mailing Address
First Line : 4351 BROADWAY
Second Line :
City : OAKLAND
State : CA
Zip : 94611-4612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4351 BROADWAY
Second Line :
City : OAKLAND
State : CA
Zip : 94611-4612
Country : US
Telephone Number : 510-535-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 06/30/2011

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