Healthcare Provider Details

I. General information

NPI: 1780502096
Provider Name (Legal Business Name): NTIMA MAMPOUYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 POWELL ST STE 900
EMERYVILLE CA
94608-1888
US

IV. Provider business mailing address

2414 HELEN AVE
VALLEJO CA
94591-4838
US

V. Phone/Fax

Practice location:
  • Phone: 510-542-5775
  • Fax:
Mailing address:
  • Phone: 510-684-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: