Healthcare Provider Details

I. General information

NPI: 1356220701
Provider Name (Legal Business Name): WHITNEY MARIE ROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CLEMENT AVE STE A
ALAMEDA CA
94501-7061
US

IV. Provider business mailing address

111 CLEAVELAND RD APT 52
PLEASANT HILL CA
94523-3885
US

V. Phone/Fax

Practice location:
  • Phone: 510-393-6720
  • Fax:
Mailing address:
  • Phone: 510-393-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: