Healthcare Provider Details

I. General information

NPI: 1053227611
Provider Name (Legal Business Name): PETRA GOJUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 OAKLAND AVE STE 201
OAKLAND CA
94611-5429
US

IV. Provider business mailing address

1517 LAFAYETTE ST
ALAMEDA CA
94501-2626
US

V. Phone/Fax

Practice location:
  • Phone: 310-741-7444
  • Fax:
Mailing address:
  • Phone: 310-741-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: