Healthcare Provider Details

I. General information

NPI: 1427466465
Provider Name (Legal Business Name): NAPOLEON NAZARENO IV NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 ADDISON ST
BERKELEY CA
94710-2047
US

IV. Provider business mailing address

2299 MOWRY AVE STE 3B
FREMONT CA
94538-1621
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-4100
  • Fax:
Mailing address:
  • Phone: 510-770-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: