Healthcare Provider Details

I. General information

NPI: 1053321612
Provider Name (Legal Business Name): CLAUDINE GABRIELLA DUTARET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE DEPT
ALAMEDA CA
94501-4399
US

IV. Provider business mailing address

6925 FAIRVIEW DR
EL CERRITO CA
94530-1829
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-3700
  • Fax: 888-375-2135
Mailing address:
  • Phone: 510-334-1482
  • Fax: 888-375-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberG80357
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG80357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: