Healthcare Provider Details

I. General information

NPI: 1962961581
Provider Name (Legal Business Name): DENISE ALOMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLIETT ALOMAR

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 MARTIN LUTHER KING JR WAY
BERKELEY CA
94704-3238
US

IV. Provider business mailing address

263 S 20TH ST
RICHMOND CA
94804-2709
US

V. Phone/Fax

Practice location:
  • Phone: 510-714-0996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number88761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: