Healthcare Provider Details

I. General information

NPI: 1033297833
Provider Name (Legal Business Name): THOMAS A. GONDA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MOUNTAIN BLVD #240
OAKLAND CA
94611-2958
US

IV. Provider business mailing address

2220 MOUNTAIN BLVD #240
OAKLAND CA
94611-2958
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-4826
  • Fax: 888-960-9076
Mailing address:
  • Phone: 510-495-4826
  • Fax: 888-960-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC50715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC50715
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG60409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: