Healthcare Provider Details

I. General information

NPI: 1124536057
Provider Name (Legal Business Name): KAYODE GBADEBO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605
US

IV. Provider business mailing address

1266 14TH ST
OAKLAND CA
94607-2205
US

V. Phone/Fax

Practice location:
  • Phone: 510-553-8500
  • Fax: 510-553-8550
Mailing address:
  • Phone: 510-273-4700
  • Fax: 510-553-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: