Healthcare Provider Details

I. General information

NPI: 1730894387
Provider Name (Legal Business Name): NEVAEH ENOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 89TH AVE
OAKLAND CA
94621-1124
US

IV. Provider business mailing address

1880 FAIRWAY DR
SAN LEANDRO CA
94577-5629
US

V. Phone/Fax

Practice location:
  • Phone: 510-850-8146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: