Healthcare Provider Details

I. General information

NPI: 1497851653
Provider Name (Legal Business Name): MAILE CONCOLINO MATIER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT EXT # 4300
BERKELEY CA
94720-4300
US

IV. Provider business mailing address

101 DALE AVE
PIEDMONT CA
94610-1013
US

V. Phone/Fax

Practice location:
  • Phone: 510-643-9134
  • Fax: 510-642-3520
Mailing address:
  • Phone: 510-652-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: