Healthcare Provider Details

I. General information

NPI: 1578214722
Provider Name (Legal Business Name): JEAN DONABEDIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 04/11/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 SANTA CLARA AVE STE 205
OAKLAND CA
94610-1323
US

IV. Provider business mailing address

PO BOX 4093
WALNUT CREEK CA
94596-0093
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-1929
  • Fax: 510-601-1947
Mailing address:
  • Phone: 949-433-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: