Healthcare Provider Details

I. General information

NPI: 1609490358
Provider Name (Legal Business Name): LAURIE VOLLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOLANO AVE
ALBANY CA
94706-1753
US

IV. Provider business mailing address

760 WILDCAT CANYON RD
BERKELEY CA
94708-1555
US

V. Phone/Fax

Practice location:
  • Phone: 510-550-7500
  • Fax:
Mailing address:
  • Phone: 510-292-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG62410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: