Healthcare Provider Details

I. General information

NPI: 1083286850
Provider Name (Legal Business Name): HIMJA TRIVEDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

V. Phone/Fax

Practice location:
  • Phone: 805-722-6786
  • Fax:
Mailing address:
  • Phone: 805-722-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number127427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: