Healthcare Provider Details

I. General information

NPI: 1376091090
Provider Name (Legal Business Name): KAITLIN RIRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 SAN PABLO AVE
OAKLAND CA
94612-1159
US

IV. Provider business mailing address

2579 SAN PABLO AVE
OAKLAND CA
94612-1159
US

V. Phone/Fax

Practice location:
  • Phone: 510-446-7100
  • Fax:
Mailing address:
  • Phone: 510-446-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: