Healthcare Provider Details

I. General information

NPI: 1841830114
Provider Name (Legal Business Name): NIGEL BURNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 UNION ST
OAKLAND CA
94607-2236
US

IV. Provider business mailing address

4641 MELDON AVE
OAKLAND CA
94619-2645
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-8000
  • Fax:
Mailing address:
  • Phone: 925-222-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: