Healthcare Provider Details

I. General information

NPI: 1457520264
Provider Name (Legal Business Name): JUNKO LAXAMANA ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 SHELLMOUND ST STE 105
EMERYVILLE CA
94608-1924
US

IV. Provider business mailing address

6001 SHELLMOUND ST STE 105
EMERYVILLE CA
94608-1924
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-1892
  • Fax: 510-601-1870
Mailing address:
  • Phone: 510-601-1892
  • Fax: 510-601-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: