Healthcare Provider Details

I. General information

NPI: 1538418462
Provider Name (Legal Business Name): DONNA MARIE LANDEZA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 WEST STREET
OAKLAND CA
94608-4536
US

IV. Provider business mailing address

2850 WEST STREET
OAKLAND CA
94608-4536
US

V. Phone/Fax

Practice location:
  • Phone: 510-874-3710
  • Fax: 510-874-3707
Mailing address:
  • Phone: 510-874-3710
  • Fax: 510-874-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberASW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: