Healthcare Provider Details

I. General information

NPI: 1780913491
Provider Name (Legal Business Name): MR. WINFRED C ARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 DURANT AVE
BERKELEY CA
94704-1725
US

IV. Provider business mailing address

494 LOS PALMOS DR
SAN FRANCISCO CA
94127-2208
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-9230
  • Fax:
Mailing address:
  • Phone: 415-584-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: