Healthcare Provider Details

I. General information

NPI: 1336982065
Provider Name (Legal Business Name): EVAN CITTADINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 BUELL ST STE A2
OAKLAND CA
94619-2861
US

IV. Provider business mailing address

201 COGGINS DR
PLEASANT HILL CA
94523-4566
US

V. Phone/Fax

Practice location:
  • Phone: 925-727-3713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: