Healthcare Provider Details

I. General information

NPI: 1306755251
Provider Name (Legal Business Name): TARA PREMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 SOLANO AVE UNIT 7683
BERKELEY CA
94707-5037
US

IV. Provider business mailing address

PO BOX 7683
BERKELEY CA
94707-0683
US

V. Phone/Fax

Practice location:
  • Phone: 510-221-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDA FONG
Title or Position: CEO
Credential:
Phone: 510-221-1145