Healthcare Provider Details

I. General information

NPI: 1275488579
Provider Name (Legal Business Name): IRIS O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA O'NEAL

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 TELEGRAPH AVE # 9
BERKELEY CA
94705-1984
US

IV. Provider business mailing address

3101 TELEGRAPH AVE # 9
BERKELEY CA
94705-1984
US

V. Phone/Fax

Practice location:
  • Phone: 510-812-7084
  • Fax: 341-946-6182
Mailing address:
  • Phone: 510-812-7084
  • Fax: 341-946-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL10120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: