Healthcare Provider Details

I. General information

NPI: 1649213307
Provider Name (Legal Business Name): KARLA ANN SAGRAMOSO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 53RD ST
OAKLAND CA
94609-1814
US

IV. Provider business mailing address

770 53RD ST
OAKLAND CA
94609-1814
US

V. Phone/Fax

Practice location:
  • Phone: 510-459-6893
  • Fax:
Mailing address:
  • Phone: 510-459-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number14104
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: