Healthcare Provider Details

I. General information

NPI: 1962809558
Provider Name (Legal Business Name): TANDEKA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 40TH ST
OAKLAND CA
94609-2633
US

IV. Provider business mailing address

390 40TH ST
OAKLAND CA
94609-2633
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-5040
  • Fax:
Mailing address:
  • Phone: 510-653-5040
  • Fax: 510-653-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: