Healthcare Provider Details

I. General information

NPI: 1346159837
Provider Name (Legal Business Name): TATUM OCHOA O'SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SKYLINE BLVD
OAKLAND CA
94619-2497
US

IV. Provider business mailing address

2901 MACARTHUR BLVD APT 111
OAKLAND CA
94602-3285
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-2306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132942
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number132942
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: