Healthcare Provider Details

I. General information

NPI: 1770629784
Provider Name (Legal Business Name): CHARLES ROYAL REPPE PA13860
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27200 CALAROGA AVE ST. ROSE HOSPITAL
HAYWARD CA
94545-4339
US

IV. Provider business mailing address

2410 RUSSELL ST APT. #C
BERKELEY CA
94705-2077
US

V. Phone/Fax

Practice location:
  • Phone: 510-264-4000
  • Fax:
Mailing address:
  • Phone: 510-843-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberPA13860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: