Healthcare Provider Details

I. General information

NPI: 1851601595
Provider Name (Legal Business Name): CHARON L FLOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CLEMENT AVE
ALAMEDA CA
94501-7063
US

IV. Provider business mailing address

2325 CLEMENT AVE
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-6300
  • Fax:
Mailing address:
  • Phone: 510-629-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: