Healthcare Provider Details

I. General information

NPI: 1548540222
Provider Name (Legal Business Name): DIEGO KUSNIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 17TH ST SUITE 210
OAKLAND CA
94612-1527
US

IV. Provider business mailing address

519 17TH ST SUITE 210
OAKLAND CA
94612-1527
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-6065
  • Fax: 510-628-9068
Mailing address:
  • Phone: 510-628-6065
  • Fax: 510-628-9068

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: