Healthcare Provider Details

I. General information

NPI: 1588353619
Provider Name (Legal Business Name): WILLETTA M FRIZZLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BONITA AVE
BERKELEY CA
94709-1909
US

IV. Provider business mailing address

150 GRAND AVE FL 2
OAKLAND CA
94612-3781
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-4765
  • Fax: 510-647-9408
Mailing address:
  • Phone: 510-899-7445
  • Fax: 510-647-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: