Healthcare Provider Details

I. General information

NPI: 1124957170
Provider Name (Legal Business Name): CHRISTOPHER PROMETHEUS PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 EMBARCADERO
OAKLAND CA
94606-5213
US

IV. Provider business mailing address

607 23RD ST # A
OAKLAND CA
94612-1719
US

V. Phone/Fax

Practice location:
  • Phone: 510-344-7069
  • Fax:
Mailing address:
  • Phone: 719-344-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: