Healthcare Provider Details

I. General information

NPI: 1902680077
Provider Name (Legal Business Name): MCILROY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 SUMMIT ST STE 2D
OAKLAND CA
94609-3416
US

IV. Provider business mailing address

5421 AZURE CT
DISCOVERY BAY CA
94505-9218
US

V. Phone/Fax

Practice location:
  • Phone: 833-423-4276
  • Fax: 888-678-2979
Mailing address:
  • Phone: 925-775-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD HARRY MCILROY III
Title or Position: CEO
Credential: MD
Phone: 925-633-4828