Healthcare Provider Details

I. General information

NPI: 1881416220
Provider Name (Legal Business Name): ELANA YOSEFA LOEB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 UNIVERSITY AVE
BERKELEY CA
94704-1023
US

IV. Provider business mailing address

439 INTERNATIONAL BLVD
OAKLAND CA
94606-2376
US

V. Phone/Fax

Practice location:
  • Phone: 510-809-3004
  • Fax: 510-809-3240
Mailing address:
  • Phone: 650-248-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: