Healthcare Provider Details

I. General information

NPI: 1487932133
Provider Name (Legal Business Name): TOBIRUS MOZELLE NEWBY TOBIRUS NEWBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY UNIVERSITY OF CALIFORNIA
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

2225 23RD AVE APT. B
OAKLAND CA
94606-4280
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-9494
  • Fax:
Mailing address:
  • Phone: 919-360-0463
  • 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:
Title or Position:
Credential:
Phone: