Healthcare Provider Details

I. General information

NPI: 1134490899
Provider Name (Legal Business Name): DEBORRAH A BREMOND PH.D. MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3407
  • Fax: 510-238-9764
Mailing address:
  • Phone: 510-428-3407
  • Fax: 510-238-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC24822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: