Healthcare Provider Details

I. General information

NPI: 1649675372
Provider Name (Legal Business Name): MERCEDES AGUIRRE-SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COOLIDGE AVE
OAKLAND CA
94602-3311
US

IV. Provider business mailing address

5328 BRANN ST
OAKLAND CA
94619-3312
US

V. Phone/Fax

Practice location:
  • Phone: 510-482-2244
  • Fax: 510-530-2047
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-530-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: