Healthcare Provider Details

I. General information

NPI: 1134637861
Provider Name (Legal Business Name): HONGMEI ZHAO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 09/24/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 SHATTUCK AVE
BERKELEY CA
94709-1410
US

IV. Provider business mailing address

1451 SHATTUCK AVE
BERKELEY CA
94709-1410
US

V. Phone/Fax

Practice location:
  • Phone: 248-840-9767
  • Fax: 248-840-9767
Mailing address:
  • Phone: 510-849-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95008310
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95008310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: