Healthcare Provider Details

I. General information

NPI: 1760670616
Provider Name (Legal Business Name): TAHA ABDELWAHHAB APRN-CNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22248 MAIN ST
HAYWARD CA
94541-4005
US

IV. Provider business mailing address

22248 MAIN ST
HAYWARD CA
94541-4005
US

V. Phone/Fax

Practice location:
  • Phone: 650-899-0762
  • Fax: 510-256-0248
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641128
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number68088
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: