Healthcare Provider Details

I. General information

NPI: 1164222790
Provider Name (Legal Business Name): RALPH NELSON PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CENTRAL AVE
ALAMEDA CA
94501-3246
US

IV. Provider business mailing address

210 CENTRAL AVE
ALAMEDA CA
94501-3246
US

V. Phone/Fax

Practice location:
  • Phone: 510-748-4023
  • Fax:
Mailing address:
  • Phone: 510-748-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210228520
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210228520
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: