Healthcare Provider Details

I. General information

NPI: 1942574421
Provider Name (Legal Business Name): DAVID ALEXANDER GUMPERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 INTERNATIONAL BLVD
OAKLAND CA
94601-2902
US

IV. Provider business mailing address

376 60TH ST
OAKLAND CA
94618-1212
US

V. Phone/Fax

Practice location:
  • Phone: 510-434-5481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: