MEDICARE: ROOTS COMMUNITY HEALTH CENTER

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	261QP2300X	Primary Care Clinic/Center	550002196	CA

General Provider Information

NPI Number	:	1851785307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	2700 INTERNATIONAL BLVD STE 11
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-1520
Country	:	US
Telephone Number	:	510-533-1248
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 INTERNATIONAL BLVD STE 11
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-1520
Country	:	US
Telephone Number	:	510-533-1248
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. NOHA ABOELATA
Credential	:	MD
Telephone Number	:	510-830-5035

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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Directions to “ROOTS COMMUNITY HEALTH CENTER ” Practice Location

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