Healthcare Provider Details

I. General information

NPI: 1316802408
Provider Name (Legal Business Name): TIMOTHY ROMANO-PUGH PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 COOLIDGE AVE
OAKLAND CA
94602-3309
US

IV. Provider business mailing address

1011 UNION ST STE 912
OAKLAND CA
94607-2236
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-6400
  • Fax:
Mailing address:
  • Phone: 510-879-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: