Healthcare Provider Details

I. General information

NPI: 1316699135
Provider Name (Legal Business Name): MR. SERGIO ABUNDIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINDEN ST
OAKLAND CA
94607-2538
US

IV. Provider business mailing address

1266 14TH ST
OAKLAND CA
94607-2247
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: