Healthcare Provider Details

I. General information

NPI: 1518390350
Provider Name (Legal Business Name): DR. K WORTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SANTA CLARA AVE STE 200
OAKLAND CA
94610-1319
US

IV. Provider business mailing address

55 SANTA CLARA AVE STE 200
OAKLAND CA
94610-1319
US

V. Phone/Fax

Practice location:
  • Phone: 510-485-0008
  • Fax: 510-485-0009
Mailing address:
  • Phone: 510-485-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY31275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: