Healthcare Provider Details

I. General information

NPI: 1639596901
Provider Name (Legal Business Name): MR. YONAS GEBREMICAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROADWAY STE 102
OAKLAND CA
94607-4099
US

IV. Provider business mailing address

1000 BROADWAY STE 102
OAKLAND CA
94607-4099
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-2294
  • Fax:
Mailing address:
  • Phone: 510-268-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: