Healthcare Provider Details

I. General information

NPI: 1306908587
Provider Name (Legal Business Name): DAVID A. IRVING MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711A MACARTHUR BLVD
OAKLAND CA
94605-4000
US

IV. Provider business mailing address

8711A MACARTHUR BLVD
OAKLAND CA
94605-4000
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-632-2576
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-632-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: