Healthcare Provider Details

I. General information

NPI: 1437989472
Provider Name (Legal Business Name): EMMA ELIZABETH SESLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 64TH AVE
OAKLAND CA
94605-1802
US

IV. Provider business mailing address

915 54TH ST
OAKLAND CA
94608-3142
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-5004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number62939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: